Thyroid gland is one of the most important and sensitive endocrine gland. As it easily responds to stress and stimuli the global incidence of hypothyroidism is increasing day by day. The major function of thyroid gland is to control the rate of metabolism. The principle function of thyroxine is to act as a catalyst –of the nature of a ‘’spark’’ for the maintenance of oxidative metabolism in most tissues. Cells in the body take their "cue" from thyroxine. The amount of stimulation the cells receive from thyroxine will determine how "quickly" they perform their functions. These functions similar with the description of agni “angati vyapnoti iti va agnihi” and “agnyate mreeyate iti va agnihi”.
Hypothyroidism results from inadequate production of thyroid hormone. Any structural or functional defects of thyroid gland that significantly impairs its output of hormones will lead to the hypo metabolic state of hypothyroidism.
The symptoms of hypothyroidism are notorious for their nonspecific nature and for the way in which they mimic many symptoms of other diseases. So it often remains undiagnosed or misdiagnosed. Vertigo, weight gain, mood disturbances, easy fatigability, tiredness, lethargy, slowness of memory, intellect and thought, menstrual irregularities, cold intolerance, dry rough skin, thin brittle hair, hair fall, Muscle stiffness, aching, myalgias, cramps, weakness and fatigue, myxedema, constipation, hoarseness of voice, goiter etc
Galaganda
There is no direct mention of thyroid gland in ayurveda. But a disease by the name galaganda is mentioned in samhitas. The earliest description of neck swelling is found in atharva veda by the name apachi. Charaka first described about the disease under the 20 varieties of sleshma vikaras. Susutha has described that out of seven layers of the skin, the sixth layer Rohini is galaganda rogadhistana (Su.Sa.4/4). In nidana sthana he described galaganda as two encapsulated small or big swellings in the anterior angle of the neck, which hang like scrotum (Su.Ni.11), whereas charaka mentioned galaganda as solitary swelling (Ch.Ch.11).
The etiological factors in galaganda include climatic conditions, water supply, dietary conditions and other surroundings etc. Susrutha stated that rivers flowing towards east might give rise to the occurrence of galaganda. Bhela described that sleepda and galaganda are more common in prachya desa1 (eastern part) of the country, and the persons consuming predominantly fish are liable to develop galgaganda2. Harita3 samhitakara described the role of dustambu and krimi dosha in the precipitation of Galaganda. Kashyapa samhitakara added that any part of the country which is cold, damp, with densely grown long trees, water stagnation and heavy rains may be prone for the development of Galaganda4.
From the above descriptions Galaganda can be correlated with goiter or some tumour pathology, where thyroid functions may or may not be affected. But hypothyroidism is not just a localized disease. It has many symptoms related to many systems of the body. So it is better not to restrict hypothyroidism with galaganda.
Management of hypothyroidism
As mentioned by charaka “vikaranamakusalo…”exact nomenclature is not necessary for all the diseases. It insists on diagnosis of constitutional status of the disease.
As per the nidana Hypothyroidism can be classified as 1.Primary (thyroid failure) 2. Secondary, (due to pituitary TSH deficit). And 3. Tertiary (due to hypothalamic deficiency of TRH), the later two are rare and may not be amicable to ayurvedic treatments.
1. If hypothyroidism results due to Genetical and hereditary defects, these come under adibala pravritta vyadhis and these are asadhya.
2. If hypothyroidism results due to Congenital defects like thyroid gland agenesis, dysgenesis, ectopic thyroid gland comes under Janmabala pravritta vyadhis. These are preventable if proper pathyapathya is followed during pregnancy.
3. The main cause of hypothyroidism is iodine deficiency, as per sarvadha sarva bahvanam-iodine containing drugs like shigru, jalakumbhi are advised here.
4. Another main cause autoimmune thyroid disease is characterized by gradual lymphatic infiltration and progressive destruction of the functional thyroid tissue. So it may be Yapya, means that the treatment should be continued Jeevanaparvantam with immuno modulatory drugs.
5. Selection of drugs acting at various levels:
Ø At hypothalamo pituitary level: anti stress drugs, medhya rasayana drugs, nasya karma may be beneficial.
Ø At thyroid gland level: thyroid stimulatory drugs are recommended here.
Ø At metabolism level: deepana, pacahana, ushna, teekshna, sukshma, lekhana drugs which pep-up body metabolism is recommended.
Ø Immuno-modulatory drugs for autoimmune related hypothyroidism.
6. As the symptoms of hypothyroidsm are notorious, the symptomatic treatment is followed according to the suitabily of the individual cases, i.e., sthoulya, sodha etc.
7. For transient hypothyroidism no specific treatment is required.
8. The patient who has complications like heart diseases like bradycardia and cardiomagaly, myxedema coma, are Pratyakhyeya indicates Achikitsavastha of Vyadhi.
YOGA:
Sarvangasana is the most suitable and effective asana for the thyroid gland. An enormous pressure is placed on the gland by this powerful posture. As thyroid gland has one of the largest blood supplies of the any organ, the pressure has dramatic change on its function, improving circulation and squeezing out stagnant secretions. After sarvangasana practice of matsyasana and halasana is beneficial. Other effective asanas include surya namaskara, pavanamuktasana with emphasis on head and neck exercises, yoga mudra, sputa vajrasana and all backward bending asanas.
PRANAYAMA:
The most effective pranayama is ujjayi. It acts on the throat and its relaxing and stimulating effects are most probably due to stimulation of ancient reflex pathways within the throat area, which are controlled by brain stem and hypothalamus. Nadi sodhana pranayama is useful in re-balancing metabolism.
The present trial drug kanchanara guggulu (Sa. Sam), is found in usage for many years for Gandhamala, Apache, Arbuda, Grandhi, Kushta, etc, has been selected to evaluate the efficacy of this drug in hypothyroidism. Its main ingredients kanchanara, varuna, triphala, trikatu, trijataka may also useful in hypothyroidism.
Shigru is a well-known plant in India. It is rich in iodine, which is an essential component of thyroid hormones, T3 and T4. It has deepana, pacahna, kapha vata hara properties. It is recommended in galaganda, kandu, sotha, apachi, vrana, medoroga, vidradhi, gulma etc.is selected as anupana along with KNG. It appears to provide it with the nutrition and substitutes the Iodine, thyroid gland require. Hence the drug is selected for the study.
The main aim of the study is
1. To normalize the levels of TSH in the fresh cases.
2. To maintain the TSH levels in the patients who are already using the allopathic drug thyronorm and gradually replacing the allopathic drug with the trail drug.
For fresh cases the trial drug started immediately after the diagnosis confirmed.
For the patients who are already using thyronorm/ eltroxin they were advised to withdraw the 25 mcg of the drug before starting the trail drug. The patients were observed carefully for 1 month, if they are comfortable with the drug and dosage and TSH levels are maintained well they are advised to withdraw another 25mcg. This way the drug will be totally replaced with the trail drug. (Full details about trial drug is in another article)
References:
1. “Sleepada galagandam cha prachysteshu drishyate.”
2. “Matsya anna bhojino nityam prachyaah syu kapha bittinah sleepdam galagandam cha prachya sastheshu drishyate.”( Bhe. Sam).
3. “Dustambu panaka…………krimijadosha ganasha gandat”(Ha. Sam).
4. Ka. Khi.25
5. Thesis (Clinical study on the effect of kanchanara guggulu and shigru patra kwath on hypothyroidism by Dr. V.Vijaya lakshmi prasuna, PG scholar; Dept of kaya chikitsa under the guidance of Dr. Prakash chander; Professor and HOD; Dept of kaya chikitsa, Dr. BRKR Govt ayurvedic college, Hyderabad.)
Drvvlakshmiprasuna , MD(Ayurveda)