2. Introduction
The endocrine system is the collection of glands produce hormones that
regulate metabolism, growth and development, tissue function, sexual function,
reproduction, sleep, and mood, among other things. The endocrine system is made
up of the pituitary gland, thyroid gland, parathyroid glands, adrenal glands,
pancreas, ovaries (in females) and testicles (in males).
Anatomical changes in body related to endocrine disorder like abnormal
endocrine development/function can impact on many different systems. For
example, insufficient maternal dietary iodine impacts on foetal thyroid gland
thyroid hormone production, which in turn can lead to abnormal neural
development. Alternatively, we now know many environmental and therapeutic
chemicals have a wide range of effects on the endocrine system.
3. The disorders relating to endocrine system
can be grossly divided into - 1. Functional abnormalities
2. Structural abnormalities
1. Functional disorders - like hypothyroidism, DM type 1, etc. are very
common in present day clinical practice.
2. Structural abnornalities- some of the common structural abnormalities
result in diseases like thyroid adenoma, goitre, undescended testis etc.
Thorough understanding of the anatomical organization of the endocrine
system can help in the clinical diagnosis of these conditions leading to early
detection. The management of many of the above disorders involves surgical
measures which also require a well off anatomical understanding.
Thyroid gland disorders are growing worldwide health issue.
Hence, Here an attempt has been made to understand rachanatmak vikruti of
thyroid gland (Goitre) from ayurvedic perspective (Galaganda).
4. Anatomy of thyroid gland
Thyroid gland is situated in the lower part of the neck, anterior to
trachea, between the cricoids cartilage and the suprasternal notch, deep
to sternothyroid and sternihyoid muscles.
It is highly vascular and soft in consistency.
Its wt.is about 30 grams and has bow tie shape.
It is asymmetrical and usually larger in the women than men.
It enlarges during puberty, in pregnancy, during lactation and in later
part of menstrual cycle.
Iodine accounts for 65% of the weight of T4. Too little iodine causes
mental retardation, goitre and other iodine deficiency disorders.
5.
6. Goitre
Goitre is the name given to a neck swelling produced by an abnormally
enlarged thyroid gland. The degree of swelling, and the severity of
symptoms produced by the goitre depend on the individual. Some cases
involve a small amount of swelling, and others can involve considerable
swelling that actually constricts the trachea and causes breathing
problems.
Most cases are categorized as 'simple' goitres that do not involve
inflammation or any detriment to thyroid function, produce no
symptoms, and often have no obvious cause.
Goitre is usually diagnosed by physical examination, but thyroid
function blood tests and scans may be used.
8. 1. Causes of Goitre
The main cause of goitre in developed countries is autoimmune disease.
Women over the age of 40 are at greater risk of goitre, as are people with a
family history of the condition.
Hypothyroidism is the result of an underactive thyroid gland, and this causes
goitre. Because the gland produces too little thyroid hormone, it is stimulated
to produce more, leading to the swelling. This usually results from Hashimoto's
thyroiditis/disease, a condition in which the body's immune system turns on
itself and causes inflammation within the thyroid gland.
Hyperthyroidism is also a cause of goitre - from an overactive thyroid gland,
which produces too much thyroid hormone. This usually happens as a result of
Graves' disease, also an autoimmune disorder in which the body's immunity
turns on itself and attacks the thyroid gland, causing it to swell.3
9. 2. Signs & Symptomes:
Throat symptoms of tightness, cough, and hoarseness
Trouble swallowing (dysphagia)
In severe cases, difficulty breathing (possibly with a high-pitch sound).
Other symptoms may be present because of the underlying cause of the goiter,
but they are not symptomatic of the goitre itself.
For example, if the cause is hyperthyroidism, the overactive thyroid can cause
symptoms such as nervousness, palpitations, hyperactivity, increased sweating,
heat hypersensitivity, fatigue, increased appetite, hair loss and weight loss.1
In cases where goitre is a result of hypothyroidism, the underactive thyroid can
cause symptoms such as cold intolerance, constipation, forgetfulness, personality
changes, hair loss and weight gain.1
10. 3. Management
Potential treatment options for goitre will depend on the
cause and the clinical picture. Options include observation,
iodine supplementation, thyroxine suppression,
thionamides (carbimazole or propylthiouracil), radioactive
iodine (I131) ablation and surgery.
Surgery is appropriate in patients who have troubling
compressive symptoms and/or fail to respond to medical
therapy. Thyroid surgery requires meticulous care to avoid
damage to surrounding structures
11. Galaganda
1.References
The earliest description of neck swelling is found in atharva veda by the
name Apachi. Charkacharya first described about the disease Galaganda. He
mentioned this in Sutra sthana 20th chapter (maharogadhyaya) under the 20
varieties of sleshma vikaras. Galganda , Gandmaala etc are described as Ek-
deshiye sotha by Acharya Charak in Trisothiya Adhyaya of Sutra-Sthana chapter
18. Sushrutacharya has described 7 layers of the skin, the sixth layer known as
Rohini is responsible for the development of Galaganda.
In Ayurvedic medicine, goitre is called ‘Galaganda’ and is described in detail. It
classifies thyroid diseases into three types;
1. Vataja (hyperthyroidism),
2. Kaphaja (hypothyroidism)
3. Medaja (thyroidal cyst).
The symptoms of these diseases are described in detail in the Ayurvedic
medicine and modern medicine.
12. 2. Etiology (Hetu) of Galaganda
In Sushruta Samhita at different places, under different topics few references for
Galganda Nidana(hetu) are available.
Since Galganda is considered as Nanatmaja type of disease of Kapha, the
provocative factors of Kapha can also be taken as the cause of it.
All Etiological factors given either for Sotha Roga or Kapha Prakopa have also
been reviewed.
In Rasavishesiya Adhyaya of Sutrasthana, Sushruta mentions that excessive use
of Madhur Rasa can produce Galganda.
In Drava Dhravya Vidhi Adhyaya of Sutrasthana, while describing the quality of
water, Sushruta mentions that, water of river of Himalaya Pradesh produces
Galgand. Today in mountaining region of Himalaya and Himachala pradesh
endemic Goiter is more common. It is due to the less iodine content in water.
In Ayurveda Galganda occurs when there is vitiation of vata and kapha
doshas, predominantly kapha which further results in disturbances of Meda
and Majja Dhatus, resulting in formation of Galganda.
Dushti of Rasadhatu plays a major role in pathogenesis
13. 3.Management
The action of kanchanara in cases of Galagand(Goitre is most probably by its
Prabhava-Gandamalanashana & not merely by rasa, guna, virya, vipaka.
Guggulu acts as rasayana, anti-inflammatory,cuts down cholesterol & aphrodisiac
which are really very beneficial in care of Goitre. Guggulsterone increases iodine
uptake.
Shigru leaves are rich in iodine; iodine deficiency is supplemented by
administering the drug which contains iodine.
Among other herbs, jatamansi, shilajit ( purified asphaltum ), gokshura and
punarnava,Mukta-pishti or Pravaala-panchaamrit, Arogyavardhini Vati,
Ashwagandha,Shatavari,Triphala,Trikatu,Tulsi,Bala and Naagbala are also used
for curative properties and the management of Galaganda.
