Role of ayurveda in the management of hypothyroidism - A case report

Alka (Babbar) (Babbar) Kapoor; Shweta Raturi

doi:10.4103/ijaim.ijaim_24_22

CASE REPORT

Year : 2022 | Volume : 3 | Issue : 2 | Page : 99-103

Role of ayurveda in the management of hypothyroidism - A case report

Alka (Babbar) (Babbar) Kapoor, Shweta Raturi
Deputy Medical Superintendent, Hospital, All India Institute of Ayurveda, 1Department of Prasuti Tantra and Stri Roga, All India Institute of Ayurveda, New Delhi, India

Date of Submission	19-May-2022
Date of Decision	24-Nov-2022
Date of Acceptance	25-Nov-2022
Date of Web Publication	12-Dec-2022

Correspondence Address:
Alka (Babbar) (Babbar) Kapoor
Room No - 5, First Floor, Admin Block, Hospital Building, All India Institute of Ayurveda, New Delhi
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijaim.ijaim_24_22

Abstract

Compromised daily habits such as more sugar intake, lack of exercise, stress, familial tendencies, etc., lead to various lifestyle diseases impacting the normal functioning of the human body systems. Hypothyroidism is one such disease that is caused due to inadequate production of thyroid hormones. The thyroid gland regulates the body's metabolism and growth. In Ayurveda, this is attributed to a function of Agni. Clinical symptoms of this disease closely resemble Agnimandya and symptoms precipitated consequentially. A 24-year-old female patient visited the hospital with complaints of irregular menstruation, heaviness all over the body, gradual weight gain, and constipation. After thorough examination and investigations, she was diagnosed with a case of hypothyroidism with increased thyroid-stimulating hormone levels. Her ultrasound findings also showed a polycystic ovary syndrome-like presentation with mildly enlarged bilateral ovaries with multiple small follicles and increased ovarian stroma. She was effectively treated with an Ayurvedic treatment approach for 5 months (five cycles).

Keywords: Artava kshaya, Ayurveda, hypothyroidism, thyroid

How to cite this article:
Kapoor A(, Raturi S. Role of ayurveda in the management of hypothyroidism - A case report. Indian J Ayurveda lntegr Med 2022;3:99-103

How to cite this URL:
Kapoor A(, Raturi S. Role of ayurveda in the management of hypothyroidism - A case report. Indian J Ayurveda lntegr Med [serial online] 2022 [cited 2023 Mar 23];3:99-103. Available from: http://www.ijaim.in/text.asp?2022/3/2/99/363110

Introduction

Diseases of the thyroid gland are among the most prevalent endocrine disorders worldwide, second only to diabetes. Hyperthyroidism, as well as hypothyroidism, occur in about 2% and 1% worldwide population, respectively. Prevalence in men is about one-tenth of that of women.^[1],[2] Reduced production of thyroid hormone is the central feature of the clinical state termed hypothyroidism.^[3] Hypothyroidism may lead to decreased libido in both sexes. In females, there may be oligomenorrhea or amenorrhea in long-standing diseases but menorrhagia may occur at an early stage. Fertility is reduced and the incidence of miscarriage is increased.^[4] Although hypothyroidism is typically rewarding to treat, about 30%–50% of individuals are either overtreated or undertreated and remain at risk of the adverse effects of thyroid dysfunction. Furthermore, a proportion of individuals remain symptomatic despite appearing to be biochemically euthyroid. The management of these patients is challenging and often unsatisfactory for patients and clinicians alike.^[5] Side effects of thyroxine replacement therapy and the long-term effect of hypothyroidism call for an effective, alternate approach for the management of hypothyroidism. The present study is a case report of a 24-year-old female presented with complaints of scanty and delayed menses (artava kshaya), heaviness all over the body (gatraguruta), weakness (klama), and constipation (vibandha). After a detailed history, clinical examination, and investigations, the patient was diagnosed with a case of hypothyroidism which was successfully managed with an Ayurvedic approach. Along with the improvement in signs and symptoms, there has been a sustained reduction in thyroid-stimulating hormone (TSH) levels with a resolution in the polycystic appearance of bilateral ovaries.

Case Report

Patient information

A 24-year-old female patient, Hindu by religion, student, moderately built, came to the outpatient department (OPD) of the hospital on February 02, 2019 (UHID No: 28330) with complaints of scanty and delayed menses (artava kshaya), heaviness all over her body (gatraguruta), weakness (klama), and constipation (vibandha).

According to the patient, she was apparently well about 1.4 years ago, when she developed complaints of incomplete bowel evacuation and also observed irregularity in her menstrual cycle. Initially, there was a decrease in interval between two menstrual cycles, which gradually started increasing with a decrease in flow. Subsequently, she developed the following symptoms, namely, feeling of heaviness, lethargy, and little or no motivation to do work, gradual weight gain, constipation off and on, irregular menses characterized by increased interval (with a cycle length of 45–60 days) of menses, scanty bleeding, blackish brown, and associated with mild pain in the lower abdomen and lower back.

Previous menstrual history

Age of menarche – 13 years, duration – 5–6 days, interval – 28–30 days, and moderate flow with mild pain in the lower abdomen and lower back.

Present menstrual history

Duration – 2–3 days, interval – 45–60 days, and scanty bleeding blackish brown associated with mild pain in the lower abdomen and lower back.

Medical history of past illness

There was no history of diabetes mellitus/hypertension or any other major medical or surgical history.

Ever since she started noticing changes in her body and menstrual cycle, she was seeking medical help but there was no relief.

Personal history

Vegetarian, nondrinker, nonsmoker, irregular or no exercise schedule owing to busy academic routine, frequent eating outside, and consumption of junk food such as pizza, burgers, and fries.

Family history

There was no relevant family history.

Clinical Findings

General examination of the patient revealed that the patient was moderately built, well nourished (apparently), able to maintain normal/ straight decubitus and afebrile. No Pallor/Icterus/cyanosis/ clubbing/enema/lymphadenopathy was observed. Hair were dry, brittle and rough. Skin was also dry. Tongue was moist and Coated. At the time of examination Pulse rate was 88/min with normal rhythm. On examination of the respiratory system, chest field was found clear with normal vesicular breathing sound and no added sounds, cardiovascular system, gastrointestinal system, and central nervous system also did not reveal any abnormality.

Patient's baseline Ultrasound (USG) of pelvic region (uterus and adnexa) suggested uterus was normal in size, shape, and echotexture, B/L ovaries are mildly enlarged. Right ovarian volume was 10 mm³ and left ovarian volume was 11 mm³ with multiple small follicles and increased ovarian stroma which is suggestive of polycystic ovaries.

(Patient had already got the USG done (August 19, 2018) and was getting treatment for polycystic ovarian disease but there was no relief, instead, symptoms were gradually adding on.

Further serum TSH was advised and it was 7.18 mIU/L as on February 2, 2019.

Ashtavidha Pariksha

Nadi Pariksha (pulse examination) revealed vata-kaphaja gati with a pulse rate of 88/min. Mala pravratti was noticed as having difficulty in defecation with hard stool in consistency; Mutra prvratti was 5–6 times a day in frequency with slight yellowish-colored urine. Jiwha was found sama (coated and moist). During shabda pariksha, the speech was found clear with formed words and sentences. During sparsha pariksha, anushnasheetata was noticed. Drik was samanya in terms of movement and appearance, eye contact was made. Akriti of the patient was found to be madhyam.

Timeline

Timeline of chief complaints

Irregular periods * 1 year 4 months; constipation (Vibandha)/incomplete bowel evacuation * 1 year; Scanty and delayed menses (Artava Kshaya) *10 months; heaviness all over the body (Gatra guruta) *10 months; weakness (Klama) *10 months; gradual weight gain * 10 months; lethargy, increased hair fall, and dry skin * 10 months.

Treatment was given for 5 months.

Diagnostic Assessment

The diagnosis was made by laboratory evaluation for thyroid function which showed increased TSH level and ultrasonography of the lower abdominal region. USG findings revealed mildly enlarged b/l ovaries with multiple small follicles and increased ovarian stroma suggestive of polycystic ovaries.

Therapeutic Intervention

After an initial assessment of the patient, Kanchnar Guggulu, Chitrakadi Vati, tablet thyrin, Kumaryasava, and a combination of Haritaki and Guduchi churna were given for 5 months [Table 1].

Table 1: Treatment advised to the patient for 5 months

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Follow-Up and Outcome

The treatment was given for almost 5 months, and monthly follow-up was done. There were five follow-ups during the course of treatment and 02 follow-ups after 5 and 15 months of stopping the treatment wherein the TSH level was assessed. Significant improvement was observed during follow-ups. At the end of 2 months, constipation was relieved. There was an improvement in the flow of the menstrual cycle. By the third follow-up, heaviness and lethargy were completely resolved. A regular menstrual cycle was achieved by the end of the 4^th month. TSH level was reduced to normal limits. Ultrasonographical findings revealed the resolution of multiple small follicles in b/l ovaries with a reduction in ovarian volume.

First visit (February 2, 2019) – The patient came to OPD with the complaint of scanty and delayed menses, heaviness all over the body, weakness, and constipation. TSH was 7.13, USG suggestive of polycystic ovaries
First follow-up (March 26, 2019) – Mild-to-moderate relief in the complaint of weakness and heaviness all over the body was noted. Constipation was relieved
Second follow-up (April 30, 2019) – USG was repeated which was suggestive of a normal study with the reduction in bilateral ovarian volume and ovarian stroma. Improvement in menstrual flow was observed. TSH showed a value of 5.246 (April 29, 2019)
Third follow-up (May 21, 2019) – The patient was feeling zestful in daily routine activity
Fourth follow-up (July 30, 2019) – S. TSH was repeated which showed a TSH value of 4.13 mIU/L (June 24, 2019). The menstruation cycle was regular with moderate flow for 5 days with intervals of 28–30 days
Fifth follow-up after stopping the medicines for 2 months, S. TSH was repeated and showed a value of 3.86 mIU/L. The menstrual cycle was also regular according to the patient
Follow-up was also done after 5 months and about 15 months after stopping the medicines. During this period, the patient was not on any medication; however, she was advised to follow pathya-apathya as advised during the treatment. TSH values were found within normal limits [Table 2].

Table 2: Serum thyroid-stimulating hormone level (before and after treatment)

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Discussion

Hypothyroidism is a clinical syndrome resulting from inadequate production of thyroid hormones. It disrupts the metabolism of the body even at the cellular level and can almost affect any organ.

Even though the disease hypothyroidism as such is not described in classical Ayurvedic texts, it can primarily be considered under the activity of Agni. Thirteen types of Agni have been described in Ayurvedic texts, the prime one being the Jathragni. Their state of equilibrium is dependent on ahara and vihar.^[6] Habitual consumption of guru, madhur, sheet, and drava food items and lack of activity, exercise, shodhan, etc., results in the vitiation of kapha which leads to Agnimandya, accumulation of ama, and dhatwagni mandyata, as was seen in the present case. Ras dhatu thus produced is vikrit in nature. Artava being updhatu of rasa dhatu thus formed is also vitiated. Obstruction of artavavaha strotas by vitiated Vata and Kapha may lead to Artava kshaya.^[7] Vitiated rasa dhatu and dhatwagnimandyata also result in the production of vitiated uttarottardhatus.^[8]

Vikrit Uttrotar dhatus, especially Meda dhatu along with vikrit kapha is responsible for the formation of granthi. In the present context, it was observed that more visible symptoms were artava kshaya, gurugatrata, and bharavriddhi, with the polycystic appearance of bilateral ovaries ultrasonographically and Increased levels of thyroid stimulating hormone (TSH) indicating the presence of hypothyroidism. This finding is also supported by a study conducted by Singla et al. which shows that the ovaries become polycystic in the presence of hypothyroidism.^[9] Hence, after thoroughly understanding the pathophysiology of the case, a treatment protocol was developed for bringing the vitiated Agni and doshas back to their natural state. To attain this, formulations having agnideepaka, strotoshodhak, vatakaphashamaka, and granthihar properties were prescribed [Figure 1]. A combination of five formulations was given as treatment, namely, Chitrakadi Vati – contains Panchkola, Kshara dwaya, ajmoda, saindhava, sauvarchala lavan,^[10] etc. The preparation mainly contains ingredients having katu vipaka, ushna veerya, and deepana, pachana properties making it perfect drug for agnideepana. It improves the jathragni, balances vata and kapha, and removes the aam from the body, leading to improved digestion and proper formation of rasa dhatu. KanchnarGuggulu – mainly contains kanchnar and guggulu. It has been described as Granthihara and Gandmalanashaka in classical Ayurveda texts.^[11] Guggulu is considered vata medohara.^[12] By virtue of its laghu, ruksha, and lekhana properties, it pacifies kapha and meda and removes the obstruction from macro- and microcirculation. It reduces the kapha and meda due to its astringent properties. Kanchnar has laghu and rukhsha properties and kashaya rasa. It has specific action (prabhava) of gandamalanashana as described in Ayurvedic texts. It reduces the kapha and meda due to its astringent properties. Tablet thyrin – It mainly contains Brahmi, guggulu, gandir, pippali, and rakta marich. In a study, hypothyroid rats were treated with 200 mg per kg of brahmi and levothyroxine has been used as a standard replacement drug. Plasma levels of thyroid hormones (T3, T4, and TSH), lipid profile, and liver antioxidants (catalase, superoxide dismutase, reduced glutathione, and lipid peroxidation levels) were determined. A histological study of the thyroid glands was carried out. The results thus obtained suggest that brahmi ameliorated hypothyroidism as evidenced by the reversal of various biochemical changes as well histology of thyroid gland in rats. Thus, the plant could be considered for therapeutic management of clinical conditions associated with hypothyroidism.^[13] Kumaryasava – Kumaryasava contains kumari, haritaki, and jatamansi^[14] as main ingredients with many other herbal drugs which exhibit hepatoprotective activity. The formulation has vatakapha shamaka and pittavardhak properties. Tikshna Guna of drugs favors the strotoshodhana. Its artavapravartana karma may help in regularizing the cycle. Drugs have deepana, pachana actions which regulate jatharagni, dhatvagni, and bhutagni, correct metabolism at the cellular level, and thus result in proper formation of dhatus and upadhatus (artava). Haritaki and Guduchi – Haritaki has been described as strotoshodhak, doshanuloman, and deepana-pachana.^[15] Similarly, Guduchi has been described as having vibandhanashana and deepaneeya properties.^[16] They collectively help in clarifying the obstructed artava vahastrotas due to their strotoshodhak and vibandhnashana properties. Haritaki being doshanulomana helps in the attenuation of doshas. Moreover, haritaki and guduchi being deepanapachana collectively pacify the accumulated Aam. The treatment was given for 5 months and the medicines given have shown promising results.

Figure 1: Samprapti vighatan

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Conclusion

The causative factors leading to hypothyroidism when viewed from the perspective of Ayurveda, may be Agnimandya and aama resulting from aahara-vihara vaishamya. Hence, the treatment plan included medicines with agnideepaka, strotoshodhak, and vatakaphashamaka properties. Symptomatic relief was observed within 1 month of onset of Ayurvedic treatment and other investigations such as USG and serum TSH were found normal even after 3 months of discontinuation of treatment. Thus, it may be concluded that treatment protocol prescribed with an approach toward correction of Agnimandya and aama may lead to the normalization of thyroid functions and alleviation of associated symptoms.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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