Role of panchakarma in Hypothyroidism.

1. ROLE OF PANCHAKARMA IN
HYPOTHYROIDISM
By Aiswarya I V

2. INTRODUCTION
 Reduced production of thyroid hormones is the
central feature of the clinical state termed
hypothyroidism.
 In India, 42 million people are suffering from thyroid
disorders Hypothyroidism - prevalence of 5.4%
 Incidence is more common in women than in men.

3. THYROID GLAND
 Butterfly- shaped highly vascular
gland.
 Anterior to Trachea between the cricoid
cartilage and suprasternal notch.
 2 Lateral lobes – on either side of the
thyroid cartilage and connected by
Isthmus.

4. THYRO
ID
GLAND
Calcitonin
Tetraiodothyronin
e-T4
(93%)
Triiodothyronine-T3
(7%)
THYROID HORMONES

5. 5
Iodine metabolism –
Iodides ingested orally are
absorbed from the GIT
into the blood.
Iodide trapping
Transportation of iodides
from the blood into the
thyroid glandular cells and
follicles through basement
membrane
Oxidation of
iodide ion-
Conversion of
iodide ions to an
oxidized form of
iodine in presence
of Peroxidase
Organification-
Binding of iodine with
the thyroglobulin
molecule to form MIT,
DIT in presence of
Iodinase
Coupling-
MIT + DIT =T3
DIT + DIT=T4
Release of
hormone-
Endocytosis – T3
and T4 into Blood

6. Negative feedback mechanism

7. Functions of THYROID HORMONES
 Increases cellular metabolic activity
 Increases the rate and secretion of digestive juices
 Stimulation of carbohydrate, fat and protein metabolism
 Regulate development and growth of nervous tissue and bones.

8. THYROID HORMONE ABNORMALITIES
.
HYPOTHYROIDISM
INCREASED TSH
NORMAL T3 AND T4
OR
REDUCED T3 AND T4
REDUCED TSH
INCREASED T3 AND T4
HYPERTHYROIDISM
Measuring serum TSH may be a primary
screening factor for existence of
Hypothyroidism

9. 9
HYPOTHYROIDISM
Hypo metabolic clinical state
Inadequate production of thyroid hormones
Tri –
iodotyrosine(T3)
Tetra – iodotyrosine
(T4)
Rarely by resistance in the use of thyroid hormones by the
peripheral tissues

10. Hypothyroidism
Primary
with goitre
with atrophic
gland
Transient
Secondary
with goitre
with atrophic
gland
Resistance to thyroid
hormone action
TYPES OF HYPOTHYROIDISM

11. TYPES OF HYPOTHYROIDISM
BASED ON CAUSE – 3 types
• Less production of thyroid hormones
T3 and T4 by the thyroid gland
Primary
Hypothyroidism
• Defect in TSH synthesis by Anterior
Pituitary
Secondary
Hypothyroidism
• Defect in Hypothalamic TRH
secretion
Tertiary
Hypothyroidism

12. • Increased TSH
• Reduced T3 and T4
• Increased TSH
• Normal T3 and T4
BASED ON T3 AND T4 LEVELS
CLINICAL
HYPOTHYROIDISM
SUB CLINICAL
HYPOTHYROIDISM

13. ADULT HYPOTHYROIDISM
CONGENITAL
HYPOTHYROIDISM
Hypothyroidism based on AGE OF ONSET
CRETINISM MYXOEDEMA

14. Etiology

15. CLINICAL FEATURES
 In adult hypothyroidism, clinical features can largely be
explained by the reduced metabolic rate and deposition
of glycosaminoglycans (GAG) in different body
compartments.
 Symptoms of hypothyroidism develop gradually.
 The term myxoedema refers to the boggy appearance
of the skin and subcutaneous tissues in the patients in
a severe hypothyroid state.

16.  Peripheral manifestations of hypothyroidism are less manifest in
patients with secondary hypothyroidism.
 Skin is pale and cool, and reduction in sweat and sebaceous
secretion causes dryness and coarseness.
 Capillary fragility causes easy bruisability.
 Scalp and body hair become dry and brittle and tend to fall.
 GAG deposition in the pharynx and larynx contributes to
hoarseness of voice.

17. Thyroid investigations
The function of the thyroid gland may be evaluated by following
ways -
 Tests of thyroid hormones in blood
 Evaluation of the Hypothalamic-Pituitary-Thyroid axis
 Assessment of iodine metabolism
 Estimation of gland size
 Thyroid biopsy
 Observation of the effects of thyroid hormones on peripheral

18. What in Ayurveda???
 No direct reference for Hypothyroidism or even Thyroid
disorders in Ayurveda
 On the basis of its clinical presentation, it can be correlated
with different entities
 Single Ayurvedic term - Difficult

19. AMA AND HYPOTHYROIDISM
स्रोतोरोधबलभ्रंशगौरवानिलमूढतााः||
आलस्यापक्तिनिष्ठीवमलसङ्गारुनिक्लमााः|
नलङ्ग
ं मलािां सामािां, निरामाणां नवपर्यर्ाः || (Ash.Su 13/23-24 )
Fluid retention
Generalized body weakness
Heaviness of body
Lethargy
Poor appetite
Constipation
Sroto rodha
Balabhramsha
Gaurava
Aalasyam, Klama
Apakthi
Anila moodatha
Malasanga
HYPOTHYROIDISM AMA LAKSHANAS

20. निनित्सा
आम निनित्सा
अल्पे – लङ्घिं
मध्यमे – लङ्घि पाििं
प्रभूते - दोषावसेििं

21. Role of Panchakarma in the
Management of Hypothyroidism

22. RUKSHANA
 मांसला मेदुरा भूररश्लेष्माणो नवषमाग्नर्ाः||
स्नेहोनिताश्च र्े स्नेह्यास्ताि् पूवं रूक्षर्ेत्तताः|
संस्नेह्य शोधर्ेदेवं स्नेहव्यापन्न जार्ते|| (A H Su 16/37)
 Internal and External Rukshana
 Internal – Pachana, Deepana
 External – Ruksha churna pida sveda, Udwarthana, Dhanyamla
Dhara

23. SNEHANA
 गुडािूपानमषक्षीरनतलमाषसुरादनध||
ि
ु ष्ठशोफप्रमेहेषु स्नेहार्थं ि प्रिल्पर्ेत्|
निफलानपप्पलीपथ्यागुग्गुल्वानदनवपानिताि्||
स्नेहाि् र्र्थास्वमेतेषां र्ोजर्ेदनविाररणाः| (A H Su 16/43-44)
 Can be done with
 Guggulu thikthaka Gritha, Indukantham gritham
 Thila Thaila, etc
SVEDANA – Pinda sveda (kaphavata hara)

24. SHODHANA
 Vamana and Virechana has got major role
 Helps in correction of agni
 Vamana - Kalpa sthanoktha yoga- madanaphala yoga
 Virechana - Gomutra hareetaki , Trvivrit Yoga, Eranda Thaila, etc
 Research Works
 Roli Bansa: Effect Of Vamana Karma In The Management Of
Hypothyroidism. International. Ayurvedic medical Journal 2016
 Pushpawati Chaudhari. et al. Efficacy of Vamana and Kanchanara
Yoga in the Management of Kaphaja Galaganda vis-à-vis
Hypothydoidism. International Journal of Biopharmaceutics. 2013;
4(2): 90-95.
 Rupesh Bade, Meenakshi Rewdkar, Raman R Ghungaralekar – A
Single Case Study of Samshodhana Karma- Virechana in
Hypothyroidism. IAMJ

25. BASTI
 Basti – Teekshna basti - Lekhana basti, Choorna basti,
Erandamooladi basti, etc
Research Work
 Sarvesh Kumar Singh. Evaluation of Vardhamana Pippali,
Kanchanara guggulu and Lekhana basti in the management of
hypothyroidism. Indian knowledge of Traditional Medicine
NASYA
 Shodhana Nasya
 Stimulatory Action

26. RASAYANA PRAYOGA
• Rasayanas are administered after proper Shodhana Karma.
DRUGS OF CHOICE FOR RASAYANA
• Bhallataka – Kaphahara, Sroto Shuddhikara, Vibandhahara.
• Lashuna - Tikshna. Removes Aavarana and does Srotoshodhana
• Punarnava – Shophahara ; Effective in Myxoedema

27. THANK
YOU