Introduction

Thyroid disease is one of the most prevalent endocrine disorders worldwide. Hypothyroidism can result from any of a variety of abnormalities that lead to insufficient synthesis of thyroid hormones. [1] Thyroid dysfunction prevalence is rising at an alarming rate in Indian population which is around 11% [2], more prevalent among the females.[3] In the past, thyroid issues arise when people hit their 40s-50s. Now many in the younger generation are diagnosed in their 20s with the higher rate of autoimmune disorders we see today. [4] [5]

According to Ayurved, hormones and metabolism fall under the category of Pitta Dosha.[6] The thyroid’s function of metabolism is synonymous with the Ayurvedic concept of Agni.[7] Vagbhat also stated that Mandagni is the root cause of all disease and thus the exacerbating factor. [8] Treatment of all the diseases is not mentioned in the ayurvedic classics due to its countless names of diseases and its innumerable clinical features. Thus, it makes impossible to put down the treatment protocol for all the diseases. Since hypothyroidism and its management is not mentioned directly in Ayurvedic classic, it is considered as an Anukta Vyadhi and it is management is dependent under the criteria of Dosha, Bheshaja, Desha, Kala, Bala, Sharira, Ahara, Satmya, Sattva, Prakriti and Vaya. [9]

            There is a wide variation of gastrointestinal manifestations from these thyroid disorders associated with autoimmunity suggesting interconnection between them. An imbalance in lifestyle and disobeying the principles of Ayurveda which includes Dinacharya, Ratricharya, Ritucharya, Bramhacharya, etc. leads to auto-immune disorders. [10] Hypothyroidism is majorly managed by therapeutic interventions like Shodhana and Shamana Chikitsa with Yoga Shastra being insufficient. Vishuddha Chakra located at the pit of the throat is often associated with the thyroid gland which on malfunctioned affects physical and mental development and dysregulates metabolism. It is observed that stimulating the Vishuddha Chakra by following the Ayurvedic principles mentioned in classics helps in preventing thyroid disorder and achieving euthyroid state. [11]

Observations and Results:

A search was undertaken in MEDLINE (www.pubmed.com) or the PubMed database. The search was limited to only English literature including those studies which were published. Also, Ayurvedic literatures like Charak Samhita, Vagbhat Samhita, Sushruta Samhita, textbook of Dravya Guna, Swasthavritta, Preventive and Social Medicine, etc. were used for this study.

Clinically, hypothyroidism is a clinical syndrome resulting from deficiency of thyroid hormones due to their insufficient synthesis which in turn results in a generalized slowing down of metabolic processes. It is characterized by a broad clinical spectrum ranging from an asymptomatic to subclinical condition with normal level of thyroxine (T4) and Tri-iodothyronine (T3) and mildly elevated levels of serum TSH to an overt state of myxoedema, end organ effects and multi system failure. They are influenced by the age of the patient, the rate at which the hypothyroidism develops and the presence of other disorders. Weight-gain, tiredness, anaemia, swelling over face, hands and feet, menstrual abnormalities, cold intolerance and dry rough skin, thin-brittle hair, hair fall, muscle stiffness and pain, weakness in the extremities, constipation, decreased appetite, mood disturbances, forgetfulness, inability to concentrate, goitre are the major presentations of hypothyroidism. In due course of time, untreated hypothyroidism may lead to number of health problems such as obesity, arthritis, heart disease, infertility etc. [12]

It is sometimes referred as “Silent Disease” as the symptoms of hypothyroidism are notorious for their unspecific nature and for the way in which they mimic many symptoms of other diseases. So, it often remains undiagnosed or misdiagnosed.[13]

The conventional treatment of hypothyroidism is thyroid hormone replacement therapy i.e., Levothyroxine. But it has certain side effects on long term use like angina, cardiac arrythmia, palpitations, tachycardia, muscle cramps, weakness, restlessness, osteoporosis etc. on the other hand, undertreatment with levothyroxine can lead to dyslipidaemia and progression of cardiovascular disease. [14]

So, there is a great need to find out a safe and effective remedy which not only relieve the symptoms but also increase in sense of well-being leading to more acceptability and better compliance. Ayurved is a science of life with sole aim of providing health to the mankind. It can offer new dimensions towards understanding the aetiopathogenesis and successful management of hypothyroidism. As far as the name of disease is concerned, no specific term is found for hypothyroidism in Ayurved classics. It can be correlated with Galaganda, Gandamala, Bhasmaka etc but the concept of hormone overproduction and underproduction is not clear. Though many diseases of current era do not find mentioned in Ayurvedic texts, yet they can be successfully treated due to deep insight provided by the Ayurvedic principles. [15]

Along with the Ayurvedic therapeutic interventions in hypothyroidism, Yoga Shastra have great impact in achieving normal functioning of the thyroid gland by performing various Pranayamas like Bhramari, Omkar Chanting, Anuloma-Viloma etc and Asanas which has impact on the neck region thereby helps in stimulation of thyroid gland function like Parvatasana, Gomukhasana, Matsyendrasana etc. Also there has been great impact found on thyroid gland function by chanting the 16 vowels and Sanskrit Shlokas of Vishuddha Chakra along with their precise meanings to achieve its optimum health benefits.[16]

Discussion

Ayurved and Thyroid Gland

There is no direct mention of thyroid gland in Ayurvedic classics, but a disease by the name Galaganda, characterized by neck swelling, is well known. Galaganda is due to vitiation of mainly Kapha Dosha but also of Vata and Medo Dhatu. Rasa Dhatu plays a major role in pathogenesis of Rasaja Vikara are similar to the clinical features of hypothyroidism. [17] Hormonal disturbances are the dysfunction of Agni. Rasa Dhatwagnimandya leads to under-production of Avipakva Rasa Dhatu and over-production of Mala of Rasa Dhatu i.e., Mala Kapha Vriddhi. Dhatwagnimandya is also the major features of the disease and all these features contribute with the modern concept of metabolism i.e., “decreased Basal Metabolic Rate”. [18]

Thyroxine and Agni

The principal function of thyroxine is to stimulate basal metabolic rate. It acts as a catalyst for the maintenance of cellular oxidative process throughout the body. Hence it has profound influence on tissue metabolism all over the body. These functions have striking similarity with the description of Agni in Ayurved. Like thyroxine hormone, all the metabolic processes of the body are under the control of normal functioning of Jatharagni and Dhatwagnis. [19] Jatharagni contribute part of itself to Sapta Dhatus. Jatharagni present in Dhatu (Dhatwagni) when hyperactive leads to wasting and when hypoactive leads to hypertrophy of respective Dhatu. This can be illustrated with hyper and hypo metabolism associated with hyper and hypo functioning of thyroid gland.[20]

Samprapti of Hypothyroidism

After analysing the clinical features hypothyroidism, it is found that pathogeneses and clinical manifestations are due to dysfunction of Agni. It all starts with faulty dietary and lifestyle habits resulting in aggravation of Mala Kapha Dosha. This increased Kapha Dosha impairs the Jatharagni with the formation of Ama Dosha. As Dhatwagni is dependant on Jatharagni, so Dhatwagni impairment occurs in due course of time. This Dhatwagni vitiation causes improper formation of Sapta Dhatu starting from Rasa to Shukra resulting in improper nourishment to the body leading to hypothyroidism. [21]

Analysis of hypothyroidism with the help of Ayurvedic principles shows the involvement of Agnimandya (Jatharagnimandya, Dhatwagnimandya), production of Ama Dosha, overproduction of Mala Kapha Dosha and Rasa Dhatu Dushti as prominent pathological features in this condition. Majority of Nanatmaj Rogas of Kapha Dosha can be included as clinical features of hypothyroidism like Tandra (Drowsiness), Atinidra (Excessive sleep), Staimitya (Timidness), Gurugatrata (feeling of heaviness in the body), Alasya (laziness), Balasaka (loss of strength), Apachana (indigestion), Hridayopalepa (feeling of heaviness over chest), Galaganda (goitre), Atisthoulya (obesity) and Shwetavabhasata (pallor). [22] Also, many of the Rasaja Vikaras which shows similarity to signs and symptoms of hypothyroidism are Ashraddha (loss of desire for food), Aruchi (anorexia), Gaurava (feeling of heaviness), Tandra (drowsiness), Angamarda (malaise), Panduroga (anaemia), Klaibya (impotency), Strotorodha (obstruction of microcirculatory channels), Agnimandya (hypo metabolic state), etc. [23] According to Ayurved, hypothyroidism can be considered as Krichhrasadhya as vitiation of Dhatwagni once created is difficult to treat and takes time to reverse the pathological changes takes place due to hypothyroidism. This vitiation of Dhatwagni if not treaty early may vitiate Shukra and Aartava resulting in congenital hypothyroidism.

Ayurvedic Management of Hypothyroidism

From above mentioned discussion, the medicines which stimulate the Agni and possess Kapha-Vatahara properties should be used for treating hypothyroidism. The dietary rules and proper lifestyle practices (Dinacharya, Ritucharya) as described in Ayurvedic texts should be followed for proper control of hypothyroidism. Ayurved has advised three fundamental modalities to manage every disease i.e., Nidana Parivarjana, Samshodhana Chikitsa and Samshamana Chikitsa.

Nidana-Parivarjana[24]: It is the first line treatment of all the disease. It means the avoidance of various causative factors of the disease. Hypothyroidism manifest as Kapha-Vata Vriddhi, Agnimandya, Ama Dosha and Rasa Dhatu Dushti. Therefore, all the Kapha-Vata Dosha aggravating factors and Agnimandyakara Ahara-Vihara [25] should be avoided in hypothyroidism.

Samshodhana Chikitsa

Hypothyroidism is considered as a chronic disease where involved Doshas are at peak level. For Pravriddha, Bahu Dosha and Jirna Vyadhi, Ayurved always suggest Shodhana therapy (body detoxification).[26] Due to dominance of Kapha Dosha in the pathogenesis of hypothyroidism, Vamana (medicated emesis therapy) and Virechana (therapeutic purgation) Karma can be performed due to its effect of clearance of vitiated Kapha and Pitta from Urdhwa (emesis) and Adho (purgation) Marga respectively.[27] For proper evacuation of bowel and to regularize Agni, Niruha Basti (therapeutic enema therapy) should be administered. In Medo Vriddhi (obesity, dyslipidaemia), Lekhana Basti can be given in this condition. [28]

Samshamana Chikitsa

Rasa Dhatu Dushti being one of the pathological features of hypothyroidism can be treated by Langhana Chikitsa [29] which includes intermittent fasting, intake of easily digestible food items, avoidance of junk food along with balanced lifestyle modifications. Similarly, Ama Dosha is managed by intervention of Jwara Chikitsa which includes Deepana (appetizers), Pachana (digestives), Langhana (fasting), Svedana (sudation), Tikta Rasa Pradhana Dravya like Guduchi, Vasa, Kantakari, etc

Yoga and Hypothyroidism

Sarvangasana (shoulder stand) is the most suitable and effective Asana for the thyroid gland. Enormous pressure is placed on the thyroid gland by this powerful posture. As the thyroid gland has the large blood supply, pressure has a dramatic effect on its function, improving circulation and squeezing out stagnant secretions. Matsyasana (Fish pose) and Halasana (plough pose) have the similar effectiveness as that of Sarvangasana. Other effective Asanas includes Suryanamaskara (sun salutation), Pavanmuktasana (wind relieving pose) with emphasis on neck and head exercise, Suptavajrasana and Trikonasana.

The most effective Pranayama is Ujjayi. It acts on throat and its relaxing and stimulating effects are most probably due to stimulation of the throat area which are controlled by the brain stem and hypothalamus. Bhramari Pranayama also found helpful. Surya, Chandra Nadi Shodhana Pranayama (right, left and alternate nostril breathing) is useful in balancing metabolism. [30]

Understanding of Vishuddha Chakra and Hypothyroidism

Vishuddha Chakra is the 5th Chakra (energy) of the human body located at the pit of throat. It is also known as throat Chakra. The word Vishuddha means pure or filtered. Shlokas 28-31 of Shata-Chakra Nirupanam describes all the different attributes of Vishuddha Chakra. Its descriptions go like, in the throat, lies the lotus called Vishuddha in the smoky purply colour. All the sixteen Swaras (vowels) along the sixteen petals of this Chakra. This sounds start from “Am” and end with “Aham”. Chanting all the shlokas related to the Vishuddha Chakra helps in activating the Vishuddha Chakra thereby helping to eliminate the disease associated with neck region. Thyroid gland is located in the front of neck i.e., it lies posterior to the sternothyroid and sternohyoid muscles, wrapping around the cricoid cartilage and tracheal rings. Thus, due to similar location of thyroid gland and Vishuddha Chakra, activation of Vishuddha Chakra helps in purifying the thyroid gland by increasing blood circulation to thyroid gland. This helps in attaining normal secretions of thyroid hormones and euthyroid state.

Conclusion

While treating hypothyroidism, many Ayurvedic therapeutic interventions mentioned in Ayurved classics should be implemented along with regular practice of Yoga Shastra. Performing Yoga Abhyasa in daily regimen along with favourable dietary and lifestyle modifications helps to protect Agni. Similarly, following rules of Dinacharya, Ratricharya and Ritucharya should be implemented. Remembering hypothyroidism as silent disease, functioning of thyroid gland should be tested at routine check-up to avoid chronicity and earliest diagnosis with accurate treatment. Since thyroid disorders are tends to become aggressive with poor status of Agni due to faulty lifestyle practices, utmost importance should be given to assess and treat it. Thyroid disorders in chronic stage are difficult to treat and can be managed mild to moderately through integrative intervention. Therefore, its early detection and customized management should be done for the normal functioning of thyroid gland.