Management of Hashimoto’s Thyroiditis through Ayurveda Under the guidance of R. Rajam, MD (Ay) Professor & H.O.D Dept. of Rasasastra & Bhaishajya kalpana Seetha. C III MD Rasasastra Govt.Ayurveda college Thiruvananthapuram

Contents Introduction Hashimoto’s Thyroiditis Ayurvedic view Drug preparation & Analysis Case study Discussion Conclusion

INTRODUCTION

Need and Significance of the Study Thyroid disease -2nd most common endocrine disorder in India next to diabetes mellitus Incidence rate of HT -0.54% in India Female prevalence is 4 times than males

More common in the Japanese Thyroid hormone replacement therapy Life long medication complication side effects

Aim and objectives of the study Evolve effective management in Hashimoto’s Thyroiditis Study the effect of varanadi gana kwatha bhavita shilajathu in the management of Hashimoto’s Thyroiditis. Improve quality of life of HT patients INTRODUCTION  

Thyroid disorders Hyperthyroidism Thyroid disorder 1° Hypothyroidism 2° 3° Most common form of primary hypothyroidism is Hashimoto’s thyroiditis (auto immune disease) .

Diagnostic criteria of HT 1 -Diffuse goiteric enlargement of the Thyroid 2 -Lymphocytic infiltration of the Thyroid gland 3 -Occurrence of thyroid auto antibodies

Signs & Symptoms of HT About the disease Chronic fatigue Weight Gain Constipation Mood disturbance Paraesthesia Menstrual disturbance Dry skin and Hairfall Bradycardia / Tachycardia Periorbital Puffiness, Urticaria, etc Signs & symptoms of other auto immune disease About the disease

Aetiology Genetic Other Autoimmune disease Infectious disease Iatrogenic causes High iodine diet Environmental pollution, fertilizers, pesticides etc. About the disease

Pathogenesis Autoimmunity to thyroid gland Destruction of thyroid cells by auto antibodies Lymphocytic infiltration Fibrosis About the disease

Complications Infertility Suppurative thyroiditis Recurrent miscarriage Preterm birth Heart failure Myxoedema

Proposed investigations Thyroid antibody (anti TPO ,anti Tg ) FNAC Thyroid Function tests- TSH , free T4  s-Chol , s-Triglyceride , C.K  Ultrasound scan Thyroid scan About the disease

Normal lab values TSH : 0.34-4.25 mIU/ml T3 : 77-135 ng/dl T4 : 5.4-11.7 μg/dl Anti Tg levels : up to 60 U/ML Anti TPO level : up to 34 IU/ML

Concept of Hashimoto’s Thyroiditis in Ayurveda

HT is manifested with many of the symptoms of, Kapha vridhi, Rasa dhathu vridhi, Dhathwagni mandhya Kaphavritha vata

Nidana Adibala pravritha Janmabala pravritha Doshabala pravritha Sanghathabala pravritha

Samprapthi Dooshivisha Agnimandya & Tridosha prakopa Dhathwagnimandhya & Ama Sthanasamshraya in Gala Hashimotos Thyroiditis

Doṣa – Tridosha Srotas – Rasa vaha (predominantly) Roga mārga – Bāhya Dooṣya – Rasa, Meda, (predominantly) Agni – Jaṭarāgni and Dhātvāgni Adhiṣṭhāna –Whole body About the disease Samprapthi ghataka

Samprapthi vighatana Kapha vata hara Mamsa medohara Srotho sodhana Agni deepana Vata anulomana

DRUG PREPARATION & ANALYSIS

Preparation of drug The principle drug is Varanadi kwatha bhavitha Shilajatu gutika. Step 1: Sodhana of Shilajatu Step 2: Preparation of Varanadi kwatha Step 3: Bhavana Step 4: Preparation of pills

In qualitative analysis Pharmaceutical study In qualitative analysis Presence of fulvic acid was observed using HPTLC finger print. Presence of steroids ,phenols & alkaloids and flavanoids were detected. In quantitative analysis Heavy metals like zinc, cadmium, Nickel &Iron were estimated in ppm levels.

CASE STUDY

48 year old male –Painter Fatigue, drowsiness(7-8 yrs) Midline neck swelling, painless & diffuse, gradually increasing in size since 2 years Sleeplessness(1 ½yrs) Constipation, weight gain, itchy skin, cold intolerance, depression, dry & coarse hair and dry skin (1yr)

He was under Thyroxine for 5½ years & stopped 3 months before hospital admission Diagnosis : Hashimoto’s Throiditis

Udhwarthana with kolakulathadi choorna for 3 days Methodology Deepana pachana with Gudoochadi kashaya & panchakola choorna in Takra – 8 days Udhwarthana with kolakulathadi choorna for 3 days Achapana with Tikthaka ghrita – 7 days

Vamana with madana pippali Peyadikrama Samana with Varanadi Kwatha Bhavitha shilajatju – 1 gm bd for 3 months

Pathyapathya Apathya. - guru, vidahi ahara,kulatha,kakmachi -exertion, exposure to bright sunlight and coldwind etc Pathya -cow’s milk, Dadima rasa etc

Evaluation of effectiveness Treatment Observation Deepana Pachana Good Appetite Achapana Itching reduced, Relieved constipation, sleep enhanced Vamana Itching was relieved totally, Samana Drug Relieved from depression etc , weight loss up to 7 kg was observed, TSH level & antibody titre in blood reduced. In USG Marked reduction in the size of thyroid nodules and features of thyroiditis were absent Follow up after 2 months TSH level was normal & there were no recurrence of previous symptoms.

Random observations Sex Age Before trial After trial TSH anti TPO Tg (<4Iu/l) (<34 IU/ML) (<60 U/ML) male 48Yrs 46 mlU/L 208.7 IU/ML 1270 U/ML 16 32 IU/ML 56 U/ML female 43Yrs 11.02 73.8 IU/ML 379.3 04.1 mlU/L 33 IU/ML 230 U/ML 55.3IU/ML 133.3 2.9 20 55 U/ML 35Yrs 40 44.11 IU/ML 320 2.1 120 200 45Yrs 7.4 325.4 75.9 3.4 28.5 70

Discussion

Shilajatu - Tridosha samana Varanadi gana - Kapha vatha prashamana Moreover shilajathu is a drug which owes yogavahithwa So on assessment it was, found to be an apt choice in this condition. Discussion

CONCLUSION

HT is a Vata kapha pradhana sannipatha roga HT is a Vata kapha pradhana sannipatha roga. So shodhana which is kapha hara & shamana which is kaphavatahara is adopted here. Varanadi Kwatha Bhavitha Shilajathu was found to be effective in normalizing TFT values and antibody titre.

Very effective in reducing symptoms associated with HT. Size reduction of goiter was observed in Sonological findings Improvement was observed in serum cholesterol level after the study. The drug shows result in obesity. .