HYPOTHYROIDISM Treatment Protocol by Ayush

NTRODUCTION

Hypothyroidismis a clinical syndrome which results from deficiency of thyroid hormones.Iodine deficiency and autoim­munity are the main causes of hypothyroid­ism out of which autoimmunity is common in iodine replete areas.1 The features of Hypothyroidism closely resembles with Shotha. However, it can be correlated with Galaganda, when it is associated with swell­ing over the neck.

Case Definition:

Patients presenting with history of weight gain, puffy face, non-pitting edema over hands and feet, constipation, hair loss and menstrual abnormality.

Differential Diagnosis-

Hypothyroidism needs to be differentiated from Obesity, PCOS in women, thyroid lymphoma, addison disease, goiter and thyroid carcinoma. However, following clinical conditions similar to Shopha described in Ayurveda need to be differentiated.

• Kaphaja Pandu: Gaurava (heaviness in body), Tandra (sleepiness), Panduta (pallor), Klama (fatigue), Svasa (dyspnea on exertion), Aalasya (lethargy), Aruchi (loss of appetite), Svaragraha (hoarseness of voice), Ushnakamita are the symptoms of Kaphaja Pandu.2
• Sthaulya: overweight, exertional dysponea.

Line of Treatment

• Nidana Parivarjana should be the first line of treatment.
• Shodhana Chikitsa – Vamana, Virechana, Lekhanabasti
• Shamana Chikitsa - Pachana, Deepana, Udwartana, Swedana
• External applications - Lepa
• Rasayana Chikitsa for Rasadhatu and Medodhatu
• Treatment according to stages and Doshik involvement
• General line of treatment prescribed mainly for Kapha Dosha

LEVEL 1: AT SOLO AYURVEDA PHYSICIAN’S CLINIC/PHC

Investigations: Though it can be clinically diagnosed based on the signs and symp­toms, Laboratory investigations are essential to confirm the diagnosis and rule out other conditions

• CBC
• Serum T3, T4, TSH

Treatment: In the initial stage when the pa­tient is suspected to have hypothyroidism­some of the following advice may be given along with diet restrictions:

Table 10.1: Medicines at level 1 for Hypothyroidism

Pathya - Apathya (Diet and life style education):

Do’s -

• Ahara: Kaphahara Ahara like Yava (barley), Bajra (millet), Jovar (pearl millet), Ragi, vegetables like radish, Sarshapa, drumsticks, Gandeera (coleus) and spices like Shunthi, Jeeraka and Trikatu, buttermilk, Ushna Jala (Luke warm water).
• Vihara: Regular exercises, Yogasanas, Pranayama like Surya Bhedana, Kapalbhati etc.

Don’ts –

• Ahara: Heavy food articles and fried preparation, refined foods such as white flour, black gram, peas, potatoes, curd, milk, fermented and bakery items,
• Vihara: Sedentary life style, day sleep, munching.

Referral Criteria: Patients not responding to above mentioned management

\LEVEL 2: CHC’S OR SMALL HOSPITALS WITH BASICFACILITIES

Clinical Diagnosis: Same as level 1 for a fresh case reporting directly.

Investigation: Same as level 1: in addition

• FT3 and FT4
• Thyroid antibodies

Treatment: If patient does not respond to the Shamana treatments, the following approach may be adopted.

Table 10.2: Medicines at level 2 for Hypothyroidism

LEVEL 3: AYURVEDA HOSPITALS AT INSTITUTIONAL LEVEL OR DISTRICT

HOSPITAL / INTEGRATED AYURVEDIC HOSPITALS

Clinical Diagnosis: As mentioned in Level 1

Investigation: As mentioned in Level 1 & 2.

Treatment: In addition to the management mentioned in Level 1 & 2, few of the fol­lowing treatment may be added as per the requirement and status of the patient.

Shodhana -

• Vamana Karma
• Virechana Karma
• Lekhana Basti

Table 10.3: Medicines at level 3 for Hypothyroidism

Rasayana -

• Shilajatu Rasayana8
• Vardhamana Pippali9
• Bhallataka Rasayana10
• Gudardraka Prayoga

Pathya - Apathya (Diet and life style education): Same as level – 1

AYURVEDIC STANDARD TREATMENT GUIDELINES HYPOTHYROIDISM

REFERENCES

1. Harrison’s principles of Internal Medicine, 17th edition chap335 pg. no. 2229.
2. Agnivesha, Charaka, Charaka Samhita edited by Vaidya Yadavaji Trikamji Acharya Chaukhamba Surbharati Prakashana, Varanasi 2011: Chikitsa Sthana 16/23,24 pg. no. 527.
3. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. of India, Part “A” Formulations. 2000, Pg. no. 206.
4. Sri Govindacharya, Bhaisajya Ratnavali with Vidyotini Hindi commentary by Sri Kaviraja Ambikadutta Shastri, edited by Acharya Rajeshwaradutta Shastri, 36/4-6, 18th edition, Chaukhambha Publications, Varanasi, 2007, Pg. no. 713.
5. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Welfare, Govt. Of India, Part “B” Formulary of List of Single Drug of Plant Origin, 2000, Sr.no.353.
6. Anonymous, The Ayurvedic Formulary of India, Ministry of Health and Family Wel­fare, Govt. of India, Part “A” Formulations. 2000, Pg, no. 664.
7. Agnivesha, Charaka, Charaka Samhita: Prameha Chikitsasthana 6/40, edited by Vaidya Yadavaji Trikamji Acharya Chaukhamba Surbharati Prakashana, Varanasi 2011.
8. Agnivesha, Charaka, Charaka Samhita: Charaka Chikitsasthana 1-3/48-59, edited by Vaidya Yadavaji Trikamji Acharya Chaukhamba Surbharati Prakashana, Varanasi 2011.
9. Agnivesha, Charaka, Charaka Samhita: Charaka Chikitsasthana 1-3/32-34, edited by Vaidya Yadavaji Trikamji Acharya Chaukhamba Surbharati Prakashana, Varanasi 2011.
10. Agnivesha, Charaka, Charaka Samhita: Charaka Chikitsasthana 1-3/13-17, edited by Vaidya Yadavaji Trikamji Acharya Chaukhamba Surbharati Prakashana, Varanasi 2011.