Positive Health Online

The incidence of Hypothyroidism is increasing day by day, and there is increasing demand to treat the disease through the Ayurvedic system of medicine, as it is completely natural and safe. Hypothyroidism can be treated effectively if we understand the disease and select the proper drugs, according to the condition and exact aetiology of the disease.

There has been slow advancement in the knowledge of thyroid disorders since the dawn of the 20th century. Awareness of the thyroid gland can be traced back as far as the first century AD when Galen, a famous Greek doctor, provided a brief description of this gland. He suggested that it functioned to lubricate the larynx, a view that was accepted for a long time. In 1656 Thomas Wharton named the thyroid, from the Greek word thyreos meaning 'Oblong shield'. He suggested that the purpose of the thyroid was to beautify the neck by giving it a rounder contour through filling the vacant spaces around the larynx.[1] 

Function of Thyroid Gland and Hormone

Even up to 1880, the thyroid was proposed as a receptacle of worms, or even a vascular shunt, to cushion the brain against a sudden increase in blood flow. The definite function of the thyroid as a controller of metabolism was studied and confirmed by George Murray, Hector Mackenzie and Edward Fox .[1, 2, 3] 

Cells respond to the thyroid hormone with an increase in metabolic activity. Metabolic activity, or metabolism, is a term used to describe the processes in the body that produce energy, and the chemical substances necessary for cells to grow, divide to form new cells, and perform other vital functions.[4, 5]

In the Rig Veda {the first of a collection of sacred ancient Hindu texts) the first Rik starts with the 'agni meele purohitam' meaning agni is purohita, the conductor of rituals to protect the pura or this body.[6]  The term agni means fire, which is a prime and ultimate factor in the maintenance of life. In vachaspatyam, agni is defined as 'nayate parinamayateeti' that which brings changes in an organism or a substance, indicating it is a key factor in transformation of consumed ahara viharadi dravyas of vijateeya (heterogeneous) origin into sajateeya (homogenous) nature. Since agni is a derivative of teja mahabhoota, it carries to paka in which the inherent feature is change. The term metabolism, which literally means change, is used to refer to all the chemical and energy transformations that occur in the body, which is nothing but the function of agni viz. 'Nayate parinaaamyateeti'.[6]

Hypothyroidism results when the thyroid gland fails to produce enough of the thyroid hormone, due to structural or functional impairment that significantly impairs its output of hormones - this leads to the hypo metabolic state of hypothyroidism. This tends to slow down the body's functions. The thyroid gland controls metabolism through the production of thyroid hormone. Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormones.[7]

Main Causes of Hypothyroidism

The main causes of hypothyroidism can be classified [8] into:

1. Primary (thyroid failure): Hypothyroidism, caused by the inability of the thyroid gland to make T3 and T4, is called primary hypothyroidism;
Primary hypothyroidism is a condition of decreased hormone production by the thyroid gland. It accounts for 95% of hypothyroidism cases; only five percent or less are suprathyroid in origin. The most common cause of primary hypothyroidism is:
       i) Iodine deficiency; 
      ii) AITDs (Autoimmune thyroid diseases);
      iii) Drugs;
      iv) Iatrogenic;
      v) Congenital.
Transient hypothyroidism includes silent and part partum thyroiditis.

2. Secondary (due to pituitary TSH deficit);
3. Tertiary (due to hypothalamic deficiency of TRH).
          
Hypothyroidism is one of the most undiagnosed and misdiagnosed diseases, as its clinical features are notorious. Hypothyroidism doesn't have any characteristic symptoms, and many symptoms of this condition can occur in people with other diseases.  Vertigo, mood disturbances, easy fatigability, tiredness, lethargy, slowness of memory, intellect and thought were the early symptoms, and Parasthesias, muscle cramps, weakness, muscles stiffness and aching were the main complaints of the chronic cases.[9]
                    

Ayurveda and the Thyroid Gland

There is no direct mention of the thyroid gland in Ayurveda, but a disease by the name Galaganda, characterized by neck swelling, is well known. The first description of neck swelling was mentioned in Atharva Veda (the last of the four Vedas) by the name apachi.  Charaka mentioned the disease under 20 sleshma vikaras.[10] Sushruta {renowned ancient Indian surgeon}in Sareera Sthana has mentioned that of the seven layers of the skin, the sixth layer Rohini is the seat of Galaganda.[11] In Nidana Sthana he described Galaganda as two encapsulated small or big swellings in the anterior angle of the neck, which hang like scrotum, [12] whereas Charaka mentioned Galaganda as a solitary swelling.[13]
         
The climatic conditions, water supply, dietary conditions, etc., are mentioned as the main aetiological factors. Susrutha  stated that rivers flowing towards east might give rise to the occurrence of Galaganda.[14] Bhela described that Sleepda and Galaganda are more common in prachya desa (eastern part) of the country, and that persons consuming predominantly fish are liable to develop Galgaganda.[15] Harita Samhitakara described the role of dustambu (contaminated water) and krimi dosha (infection) in the precipitation of Galaganda.[16] Kashyapa Samhitakara added that any part of the country that is cold, damp, with densely grown long trees, water stagnation and heavy rains may be prone for the development of Galaganda .[17]

A case of Galaganda attended with difficult respiration, a softening of the whole body, weakness, a non relish for, loss of voice, as well as the one which is more than of a year's standing should be abandoned by the physicians to be incurable.[18]  Although these facts were mentioned centuries ago, it is still an accepted fact that environmental factors, especially iodine, plays an important role in the functioning of the thyroid gland. Any imbalance in iodine metabolism can upset the thyroid condition; either too much or too little iodine can result in the development of goitre. So the areas where the soil is depleted, also the soil content in which food grows, the drinking water and goitrogenic foods, play a vital role in disease process. As far as consuming fish or any seafood goes, all a rich source of iodine, an excess may be a causative factor.[19]

From the above description we can say that Galaganda is a condition related to thyroid gland. But hypothyroidism is not just a local disease; it has many symptoms related to many systems. So it is better not to restrict hypothyroidism with Galaganda as mentioned in the classics.

Planning of Treatment                    

''Vikaranamakusalo na jihriyat kadachana Nahi sarva vikaranam namoto asti dhrivasthitih''.[20]
- Cha Chi. 18/44
                  
Ayurveda doesn't emphasize the exact nomenclature of the diseases; rather it insists on diagnosis of the constitutional status of the disease as mentioned in Charaka.[20] 

Based on Ayurvedic principles, the following are the main causes for hypothyroidism.

1. Genetical and hereditary defects come under Adibala Pravritta Vyadhis,[21] so no treatment is suggested;
2. Congenital defects come under Janmabala Pravritta Vyadhis [21] (the disease present from birth itself, i.e. congenital defects). Thyroid gland Agenesis, Dysgenesis, Ectopic thyroid gland come under this category;
3. Iodine deficiency is the main common cause for hypothyroidism. So 'Sarvadha sarva bhavanam samanyam vriddhikaranam' [22] applies here;
4. Auto immunity is another common cause, so immuno modulatory drugs are recommended here;
5. Side-effects of surgery and radiation: Kasta Sadhya [23] (difficult to treat);
6. For transient hypothyroidism no specific treatment is required;
7. If there is functional loss of thyroid tissue, or functional defects, thyroid stimulatory drugs are beneficial;
8. Selection of drugs acting at various levels:[24]

• At Hypo-thalamo pituitary level: anti-stress drugs, Medhya Rasayana [25] drugs, Nasyakarma [25] may be beneficial;
• At thyroid gland level: thyroid stimulatory drugs are recommended here; 
• At metabolism level: Deepana, Pacahana, Lekhana [25] drugs which pep-up body metabolism is recommended;  
• Immuno modulatory drugs for autoimmune related hypothyroidism.

'Samprapti vighatana' [6] is one of the main principles of treatment. Whatever may be the aetiology of the disease, it results in under-active condition of the thyroid gland and, ultimately, the slowing down of the body's metabolism. So the treatment should aim to stimulate the thyroid gland. Thyroid stimulatory drugs like Guggul should be selected to treat the disease.

As symptoms of hypothyroidism are notorious, symptomatic treatment is based to suit individual cases, i.e. sthoulya (obesity), menstrual irregularities, etc.

Pathyapathya {Regimes to be followed during Treatments}

Eating goitrogenic foods such as rapeseed, cabbage, Brussels sprouts, broccoli, cauliflower, sweet potatoes, maize, lima beans, soya and pearl millet should be limited. These foods contain natural goitrogens, which are chemicals that cause the enlargement of the thyroid gland by interfering with thyroid hormone synthesis. Cooking is known to make the goitrogens elements less effective, but it would be wise not eat these foods raw.[27]

Smoking depresses TH levels and produces chronic underlying hypothyroidism. Research shows that nicotine increases the synthesis of T3 from T4 in the brain, while alcohol and opiates block the breakdown of T3 in the brain.

Foods that contain iodine, such as kelp, beetroot, radish, parsley, potatoes, fish, oatmeal and bananas, should be kept in the diet.     

Vihara

Another important factor in the treatment of hypothyroidism is exercise. Exercise increases tissue sensitivity to the thyroid hormone, and stimulates thyroid gland secretion. An exercise regime of between 15-20 minutes per day benefits hypothyroidism. This exercise needs to be strenuous enough to raise the heartbeat, such as walking, swimming, running and cycling, except in the case of who also have generalized hypotonia, as they may be at risk of ligamental injury, particularly from excessive force across joints.  Physical and emotional stress inhibits thyroid gland secretion due to reduction of thyrotrophin output. So reduction of stress is essential for proper functioning of the gland.

Yoga [28]                  

Sarvangasana {shoulder stand}is the most suitable and effective asana for the thyroid gland. Enormous pressure is placed on the gland by this powerful posture. As the thyroid gland has a large blood supply, pressure has a dramatic effect on its function, improving circulation and squeezing out stagnant secretions. Also beneficial after Sarvangasana is the practice of Matsyasana (fish pose) and Halasna (plough pose).  Other effective asanas include Surya Namaskara (Sun salutation), Pavanamuktasana (wind relieving pose) with emphasis on head and neck exercises, Supta Vajrasana (sleeping thunderbolt pose) and all backward bending asanas.

Pranayam [28]

 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 the brain stem and hypothalamus. Surya, Chandra, Nadi Sodhana pranayama (right, left and alternate nostril breathing) is useful in re-balancing metabolism.

References