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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 1  |  Issue : 1  |  Page : 18-22

Management of Hashimoto's Thyroiditis through Ayurveda


1 Dept. of Rasa shastra and Bhaishajya kalpana, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India
2 Govt. Ayurveda College, Thiruvananthapuram, India
3 Dept. of Kaya chikitsa, Vaidyaratnam PS Varier Ayurveda College, Kottakal, Kerala, India

Date of Web Publication7-Jul-2022

Correspondence Address:
Seetha Chandran
Dept. of Rasa shastra and Bhaishajya kalpana, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2667-0593.350094

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  Abstract 


Hashimoto’s Thyroiditis (HT) is the most common auto-immune thyroid disease and the commonest cause of hypothyroidism. In conventional medicine, treatment of choice for HT is replacement of thyroid hormone. A case of HT was managed at the OPD level by following Ayurveda principles and found to be effective. A treatment protocol was designed based on the signs and symptoms and assigned in this patient. Snehapana followed by Vamana and Virechana and at the end Shamana was done with Varunadi kwatha bhavita shilajatu for a period of three months with two months follow up. The treatment protocol was found to be effective in symptomatic and biochemical profiles of the patient. Patients of HT should be able to have a choice against the lifelong hormone therapy. This can be achieved by adequate evaluation of the individual action of the therapies adapted here and replicating the same in a much larger group.

Keywords: Case report, Hypothyroidism, Thyroiditis


How to cite this article:
Chandran S, Rajam R, Patgiri B J, Mangalasseri P. Management of Hashimoto's Thyroiditis through Ayurveda. J Ayurveda Case Rep 2018;1:18-22

How to cite this URL:
Chandran S, Rajam R, Patgiri B J, Mangalasseri P. Management of Hashimoto's Thyroiditis through Ayurveda. J Ayurveda Case Rep [serial online] 2018 [cited 2022 Dec 9];1:18-22. Available from: http://www.ayucare.org/text.asp?2018/1/1/18/350094



Introduction: Hashimoto’s Thyroiditis (HT), is the most common auto-immune thyroid disease, with fluctuating thyroid function and the commonest cause of hypothyroidism in iodine sufficient areas of the world. [1],[2] It is primarily a disease of women, with a sex ratio of approximately 7:1 and can also occur in children.[2] In an epidemiological study conducted in India, prevalence of >20% was recorded.[3] Incidence rate of HT is 0.54% in India. The cause of HT is thought to be a combination of genetic susceptibility and environmental factors.

It is characterized clinically by gradual thyroid failure, with or without goitre formation, due to auto-immune- mediated destruction of the thyroid gland involving apoptosis of thyroid epithelial cells.[4] Graves’ disease and HT are closely related patho-physiologically.[2] HT has many serious complications like infertility, suppurative thyroiditis, recurrent miscarriages, preterm birth, heart failure etc. Diagnosis of HT is made clinically and biochemically. 90 per cent of HT patients have high anti- thyroid peroxidase (TPO) and anti-thyroglobulin (Tg) antibody which confirms the autoimmune pathology.[5]

The treatment of choice for HT is replacement of thyroid hormone. The drug of choice is individually tailored and titrated levothyroxine sodium administered orally. [6] But, a long term hormonal therapy is not always free from complications as well as side effects. Moreover, it is unfeasible to revert the antibody blood parameters in HT with modern medicine.

Currently, hypothyroid patients are opting for Ayurvedic management due to dissatisfaction in modern regime. A case of HT was managed through treatment protocol based on the clinical features and managed by following Ayurveda guidelines.

Case report: A 48 year old male patient, painter by profession, who was apparently well fourteen years back, developed progressive fatigue and drowsiness initially. Then after two years (2005), he gradually developed mild neck swelling that became diffuse, painless and slowly increased in size. These symptoms were followed by sleeplessness, weight loss and palpitation. He was diagnosed as Hyperthyroidism and was put on Tab. Methimazole 20 mg/day (anti-thyroid medication) for two years (2007 - 2009). Then he was on irregular follow up for one year. In 2011, he developed new complaints like constipation, nocturnal itching associated with mild eruptions, cold intolerance, depression, hoarseness of voice, dry hair and skin. Blood investigations at this stage revealed Hypothyroidism. Radio iodine uptake and Fine needle aspiration cytology (FNAC) were advised in 2011 to rule out malignancy. Radio iodine study detected enlarged thyroids with high uptake, no cold area and retrosternal extension suggestive of multi nodular goiter (MND) and Thyrotoxicosis. Aspirate of FNAC showed occasional groups of follicular cells and few collection of lymphocytes and histocytes in a background of blood and colloid, suggestive of Thyroiditis and he was administered Tab. Levothyroxine. He was kept on varying doses of drug (50 mg - 100 mg) based on his hormone level. But he didn’t get much relief from any of the above symptoms. As, Thyroid Stimulating Hormone (TSH) levels were not coming into physiological range, he stopped the medication against medical advice four months before his first visit to OPD of Govt. Ayurveda College, Thiruvananthapuram in July 2012. Symptoms like severe sleeplessness due to nocturnal itching, weight loss, excessive appetite, constipation and cold intolerance were the chief complaints during his visit to the OPD. On examination there was mild swelling of thyroid gland, dryness of skin and palpitation.

Patient was provisionally diagnosed as Kapha avrita vata (vata obstructed by Kapha) with Pittaanubandha (associated with Pitta) based on the presenting complaints like Sheeta asahishnuta (cold intolerance), Swara graha (hoarseness of voice), Dourbalya (tiredness).[7] Avarana (obstruction) is the encompassing of metabolic pathways by vitiated body humors. Symptoms like Galapaka (inflammation of thyroid gland), Atyagni (excessive appetite) can be attributed to Pittanubandhatwa.

The treatment was started with internal and external Rookshana (desiccating) therapy. The treatment protocol assigned for this patient was Rookshana and Snehapana (internal administration of medicated ghee) followed by Vamana (therapeutic emesis) and Virechana (therapeutic purgation) followed by Shamana (pacification) with Varunadi kwatha bhavita shilajatu gutika. Treatment schedule followed is enlisted at [Table 1].
Table 1: Treatment Schedule

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Observations: Clinical features, Serum Thyroid fuction test (TFT) values, TPO and Tg Antibody titre and Thyroid gland sonography were assessed before and after the treatment [Table 2]. Patient reported increased appetite and normal bowel movements after Deepana and Pachana. But, mild constipation and dryness of skin was observed during Udwartana. By Achapana, complaints like itching, constipation, sleeplessness and dryness of skin were alleviated. Itching was completely subsided after Vamana and palpitations after Virechana. Enhanced complexion was also noticed after Virechana. After administration of Shamana drug; relief in depressive symptoms were observed. Blood parameters were improved approaching towards normal value after Shamana chikitsa. Both thyroid lobes were normal in size, hypoechoic and showed coarsened parenchymal echotexture with increased vascularity before trial. But after the trial, normal size of the lobes was maintained with changed texture to hyperechoic, showing a good prognosis.
Table 2: Effect on TFT & Thyroid Antibody parameters

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After two months follow up, TSH level came down to 10.3 mIU/L and with in the next month, it became 6 mIU/L. No recurrence of previous symptoms were observed till date. The treatment made a pleasing improvement in his quality of life.

Discussion: Autoimmunity is the main culprit in Hashimotos Thyroiditis, impairing cellular metabolism. Use of immuno-modulatory, anti-inflammatory drugs and other molecules that clears the nutrition pathway through correction of digestion and metabolism will help in breaking the pathology.

On analysis of signs and symptoms, the patient was found to have Vata kapha pradhaana sannipatika doshadushti (vitiation of all three body humors). An apt drug in this condition should cause Sroto shodhana (removes blocks in metabolic pathways) by elimination of vitiated kapha pitta and Anulomana of Vata. Patient was responding positively to Deepana and Pachana (corrects digestion and metabolism through augmenting the digestive fire), Rookshana (desiccating), Ushna (hot), and Vamana treatment procedures.

Thus, the patient was treated on the line of mitigation of Kapha and pacifying Vata (vata anulomana). As the patient was having vitiation of Pitta too; Pitta hara drugs and therapies were also included in the protocol. Agni deepana (kindle digestive fire) was done initially to correct the digestion and metabolism.

So, Guduchyadi kashaya[11] and Panchakola choorna [12] in Takra was advised in the initial stage to achieve Ama pachana, Agni deepana and to subside vitiated Kapha and Pitta. Rookshana was induced by means of Panchakola choorna internally and Udwartana with Kola kulathadi choorna.[13] This was followed by Sneha pana as Poorva karma of Shodhana. Both Vamana and Virechana are adopted as Shodhana procedures in this case. Vamana helps in eliminating vitiated Kapha dosha, while Virechana helps in eliminating vitiated Pitta dosha. Shamana drug prepared by doing seven Bhavana of Shilajatu in Varunadi Kwatha. Both the drugs have Katu vipaka and Ushna virya in general. They also possess Agni deepana, Medohara and Lekhana properties. Shilajatu is Tridosha shamaka and Varunadi gana is Kapha vata prashamaka. Thus these qualities of drug intensely suit the disease condition.

Micro-level Dosha correction will be ensured by the Varunadi kwatha bhavita shilajatu and the reach of the drug up to Medo dathu level explains the rationale behind the success of the treatment protocol.[14],[15] Moreover the drug Shilajatu opted here is a Rasayana with multifaceted action.

Conclusion: The treatment protocol containing Rookshana, Snehana, Vamana and Virechana followed by Shamana drug Varunadi kwatha bhavita shilajatu is followed in this case of HT. This protocol is found to be effective in clinical, biochemical and sonological aspects. Though no drugs were given during the follow- up period, symptomatic relief was maintained. Patients of HT should be able to have a choice against the lifelong hormone therapy. This can be achieved by adequate evaluation of the individual action of the therapies adapted here and replicating the same in a much larger group.

Source of support: Nil.

Conflicts of interest: None declared.



 
  References Top

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Jaume JC. Endocrine autoimmunity. In : Gardner DG, Shoback DM, editors. Greenspan’s basic & clinical endocrinology. New York: McGraw-Hill Medical; 2007. p. 59-79.  Back to cited text no. 1
    
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Ambika GU, Sanjay K, Rakesh KS, Ganapathi B, et al. Prevalence of hypothyroidism in adults: An epidemiological study in eight cities of India. Indian journal of Endocrinology and Metabolism 2013; 17(4): 647-652.  Back to cited text no. 3
    
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George JK, Tanja D, Jennifer G, Michael K, et al. Thyroid Stimulating Antibodies Are Highly Prevalent in Hashimoto’s Thyroiditis and Associated Orbito pathy. J Clin Endocrinol Metab 2016; 101(5): 1998-2004.  Back to cited text no. 4
    
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Debmalya S. Spectrum of Hashimoto’s thyroiditis: Clinical, biochemical & cytomorphologic profile, Indian J Med Res. 2014; 140(6): 710-712.  Back to cited text no. 5
    
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Harishastri P, editor. (9th ed.) Commentary Sarvangasundara of Arunadatta on Ashtanga Hridayam of Vagbhata, Chikitsa Sthana; chapter 19, verse 7-10. Chowkhambha Orientalia; Varanasi: 2005. p. 711.  Back to cited text no. 8
    
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Acharya YT, editor. (9th ed.) Sushruta Samhita of Sushruta, Sutra Sthana; chapter 38, verse 51. Choukambha Orientalia; Varanasi: Reprint 2009. p. 167.  Back to cited text no. 11
    
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Pandey GS, editor. (7th ed.) Commentary of Chunekar KC on Bhavaprakasha Nigantu of Bhavamishra, Hareetakyadi varga; chapter 1, verse 72-73. Choukambha Bharati Academy; Varanasi: 2010. p. 25.  Back to cited text no. 12
    
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Shivaprasad S, editor. Ashtanga Sangraha of Vagbhata, Chikitsa Sthana; chapter 23, verse 2. Chowkhambha Sanskrit Series; Varanasi: 2008. p. 564.  Back to cited text no. 13
    
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Kashinatha Shastri, editor. Rasa Tarangini of Sadananda Sharma, chapter 22, verse 84-87. Motilal Banarasi Das; Varanasi: 2004. p. 586.  Back to cited text no. 14
    
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Harishastri P, editor. Ashtanga Hridayam of Vagbhata, Sutra Sthana; chapter 15, verse 21. Chowkhambha Orientalia; Varanasi: 2005. p. 236.  Back to cited text no. 15
    



 
 
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