1. 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

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

3. INTRODUCTION

4. 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

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

6. 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

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

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

9. 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

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

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

13. Complications Infertility Suppurative thyroiditis
Recurrent miscarriage
Preterm birth
Heart failure
Myxoedema

14. 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

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

16. Concept of Hashimoto’s Thyroiditis in Ayurveda

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

18. Nidana Adibala pravritha Janmabala pravritha Doshabala pravritha
Sanghathabala pravritha

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

20. 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

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

22. DRUG PREPARATION & ANALYSIS

23. 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

24. 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.

25. CASE STUDY

26. 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)

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

28. 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

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

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

31. 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.

32. 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

33. Discussion

34. 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

35. CONCLUSION

36. 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.

37. 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. .