Words: Drs Nigam PAUDEL, Amulya DAHAL, Bijendra SHAH & Sangita MAHARJAN
Hypothyroidism refers to any state that results in a deficiency of the thyroid hormones, including hypothalamic, or pituitary, disease and generalised tissue resistance to thyroid hormone and/or disorders that affect the thyroid gland directly.
It is a condition associated with deficiency in the thyroid hormones, free thyroxine [FT4] and free triiodothyronine [FT3]. T4 is produced only from the thyroid, whereas T3 emerges from the thyroid and T4 from de-iodination in extra-thyroidal tissues. T3 deficiency is responsible for the clinical and biochemical manifestations of hypothyroidism. T4, the main product of the thyroid gland, circulates in plasma. It is converted to T3. T4, in many respects, is considered as a prohormone for the more potent T3.
Hypothyroidism can result from a defect anywhere in the hypothalamic-pituitary-thyroid axis, either insufficient thyroid stimulating hormone [TSH] from the pituitary, or insufficient thyrotropin-releasing hormone [TRH] from the hypothalamus. In a vast majority of cases, it is primary hypothyroidism, involving a decreased secretion of T4 and T3 by the gland itself. This results in a compensatory increase in TSH secretion. The combination of a low serum T4 and a high serum TSH concentration confirm the diagnosis of hypothyroidism. Hypothyroidism can also be secondary due to the lack of thyroid hormone when the hypothalamus secretes a deficient amount of either thyrotropin, or thyrotropin releasing hormone. The patient’s presentation may vary from asymptomatic to coma [rarely] with multisystem organ failure [myxoedema coma].
Studies have shown the tendency of hypothyroidism to increase with age; it is more common in women. Men are also affected, but less frequently. The diagnosis and treatment of hypothyroidism are often considered simple, but there are a large group of people with this condition who aren’t treated adequately. On the other hand, the treatment modalities of hypothyroidism are also having several adverse effects. This is why patients with abnormalities of thyroid gland function receive medical attention for several reasons, while seeking its treatment through Ayurveda. It is also the need of time to go for a safe and effective management for hypothyroidism with Ayurveda principles.
The Ayurveda Perspective
Although there is no exact mention of any disease condition similar to hypothyroidism in Ayurveda classical texts, a disease, galaganda, characterised by neck swelling, is a common symptom. The first description of neck swelling was mentioned in Atharva Veda by Apachi. Acharya Charaka mentioned the condition under 20 sleshma vikaras. Acharya Susruta also has clearly mentioned the adhisthana of galaganda out of seven layers of the skin; the sixth layer known as rohini is the site for establishment of galaganda. At the other end, galaganda is closely associated with goitre [abnormal swelling of the thyroid gland]. Hypothyroidism is not just a localised disease, because it is presented by a number of symptoms related to several systems of the body. As a symptom of thyroid disease, goitre is generally associated with hyperthyroidism, but it can also occur with hypothyroidism. Thus, it is, perhaps, insignificant to draw a correlation between hypothyroidism and galaganda.
Symptoms
Malaise, lethargy, slow speech, slow pulse, low appetite, weight gain, thick skin, menorrhagia, macroglossia, goitre, and puffy eyes and face represent a kapha vitiation. Similarly, symptoms like fatigue, constipation, muscle cramps, amenorrhoea, PCOD, weakness, dry skin and hair with hoarseness of the voice are classically associated with vata vitiation.
Inherited disorders of enzyme abnormality would seem to correlate with agni in the thyroid gland. Dehagni, or jatharagni, or body fire, is responsible for our lifespan, colour, complexion, strength, health, enthusiasm, plumpness, immunity, energy, heat-processes and vital breath. One can even die with the extinction of this jatharagni and one can also live a long healthy life without the disorder with the proper functioning of the agni. Yet, its impairment gives rise to disease. The food we take nourishes the dhatus, ojas, strength, complexion and so on which ultimately depend upon agni.
Oxidative metabolism, carbohydrate, lipid, protein and vitamin metabolism are among the basic physiological functions of thyroid hormones in the body — this discloses that the thyroid gland is also responsible for basic metabolic functions, like digestion, absorption, assimilation and metabolism of food. Any imbalance in the intake of food and nutrients may cause over-activity, or under-activity, of the thyroid gland.
Role Of Food
Food plays a vital role in the occurrence of thyroid disorder. And, this may possibly suggest that viruddha ahara vitiates agni. Regulating agni with dipana dravyas to increase metabolism is essential, followed by clearing of ama. Lekhanas may also be used to reduce excess weight.
Chronic deficiency of iodine can also cause goitre hypothyroidism. In fact, there is evidence that too much iodine can cause as much trouble for the thyroid as too little. The principle of sarvadha sarva bhavanam samanyam vriddhikaranam is applied in the case.
There are a number of herbs which are effective in managing hypothyroidism. Kanchnar [Bauhinia tormentosa] is considered as a drug of choice in both the enlargement of the thyroid as well as hypothyroidism. It is typically mixed with another herb, guggulu [Commiphora mukul], in the form of Kachnar guggulu. Guggulu is also a fat burning herb due to its light, dry, and sharp nature. Thanks to its dipana, pachana, and lekhana property, it alleviates both vata and kapha and regulates agni. It also appears to alleviate several indicators of heart disease, common among hypothyroid patients, including high cholesterol and high blood pressure. Brahmi [Bacopa monnieri] was found to stimulate thyroid functioning, increasing T4 by 41 per cent. Brahmi is a well-known herb for memory loss, a symptom of hypothyroidism.
Similarly, research shows that extracts of ashwagandha [Withania sonifera] along with Bauhinia purpurea were capable of stimulating thyroid function in female mice. Bauhinia purpurea enhanced both T3 and T4 hormones, but ashwagandha only increased T4. Ashwagandha alone was found to stimulate thyroid function by increasing serum T3 and T4. A study conducted on patients with bipolar disorder found that ashwagandha root unexpectedly healed subclinical hypothyroidism. Decoction of varuna root with honey is also recommended in the management of gandamala. Varuna also possesses anti-tumour properties. This makes it beneficial in extra growths of thyroid gland as well as in hypertrophy of the prostate. Grounded root of nirgundi with water is used for nasya in the treatment of gandamala.
Yoga can also help in managing hypothyroidism with certain asanas and pranayama. The yogasanas can help in strengthening muscles and also reducing the effects of hypothyroidism. Suryanamaskar, naukasana, matsyasana, bhujangasana, ustrasana, halasana and sarvangasana are useful asanas, while suryabhedana, anulombilom and ujjayi are beneficial pranayamas.
Discussion
Hypothyroidism is a major health issue in today’s context, and treatment modalities and medicines available are not helping much in resolving the underlying pathology; instead, reoccurrence rates are high with notable side-effects.
The fundamental treatment principle of Ayurveda is nidana parivarjana — avoiding the causative factors like improper ahara, vihara and manasika karanas, which are the root cause for any disease to occur. The incidence of hypothyroidism may be due to iodine deficit dietary habits, intake of excess goitrogenic diet, inactivity of thyroid gland, toxins developed in the body by environmental pollution, or auto-immune mechanism.
When the understanding in Ayurveda and modern perspective of managing hypothyroidism emphasise on nidana parivarjana, i.e., restraining from unhealthy food habits and lifestyles and maintaining a healthy dietary regimen [pathya ahara], practising yoga asanas mentioned in ancient Ayurveda texts, avoiding things that causes stress, maintaining proper sleep [vihara and manasika pathya] and practicing pranayama will help remove thyrotoxins from the body. This also helps in improving the immune resistance and the auto-immune aspect of thyroid gland. Maintenance of proper blood circulation to thyroid gland, in turn, nourishes it with proper nutrient supply. This controls the underactivity, or hyperactivity, of thyroid gland.
The conceptual analysis of symptomatology of hypothyroidism aids us to identify it as kapha pradhana tridosha vyadhi with rasa and medo dushti predominantly resulting in agni dusti. The treatment can be planned based on dosha pratyaneeka chikitsa than vyadhi pratyaneeka chikitsa. Use of rasayanas will also bring good results in managing the condition.
Formulations to resolve the agnimandhya condition should be prescribed. The sodhana chikitsa also helps in improving agni.
The majority of the herbs recommended for this condition not only provide relief in various symptoms, but also directly alter the secretions of the hormones involved in the pathogenesis of the disease and stimulate the normal functioning of the thyroid gland. Yet, stringent clinical studies on the herbs cited are necessary to further certify their efficacy in normalising thyroid dysfunction. This will provide practitioners with better options to treat disease.
Conclusion
It may be concluded that hypothyroidism can be very well managed with Ayurveda medicines, depending upon the symptoms and careful selection of drugs — since Ayurveda attempts to heal the root imbalance of hypothyroidism. Herbal extracts possess natural antioxidants; they not only help in treating the disease, they also improve the body’s defence system. Extensive randomised control trials are also imperative for scientific validation of Ayurveda drugs for hypothyroidism, along with appropriate lifestyle management.
