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The Thyroid gland is one of the most important organs of the endocrine system as it regulates nearly all the

bodily functions including metabolic, respiratory, cardiovascular, digestive, nervous and reproductive system

either directly or indirectly. Lack of thyroid hormone or resistance of the body tissue to the thyroid hormone

in recollecting day to day things and dryness of skin since 4.5months. The patient was treated phase-wise. In

first ohase patient was administered with sarvanga udwartana, sarvanga abhyanga and bashpa sweda for 10 days

followed by virechana karma. In the second phase the patient was advised with a set of shamana aushadhi which

was modified periodically according to symptoms. There were no side effects observed during and after

treatment. Patients got complete relief in all symptoms and there was significant difference in TSH value after

the treatment.

Hypothyroidism, also known as underactive thyroid disease, is a common endocrine disorder where the thyroid

gland does not produce enough thyroid hormones. These hormones are crucial for regulating metabolism, and

immune system attacks the thyroid gland. Other causes include iodine deficiency, surgical removal of the

thyroid, radiation therapy, certain medications, and congenital hypothyroidism (present at birth). Less

commonly, hypothyroidism can result from disorders of the pituitary gland or hypothalamus, which are

responsible for signalling the thyroid gland to produce hormones.

The signs and symptoms of hypothyroidism can vary widely depending on the severity of hormone deficiency

and the duration of the condition. Common symptoms include fatigue, weight gain, cold intolerance, low body

temperature, constipation, dry skin, Hair loss, Muscle weakness and joint pain, Depression, Memory problems,

decreased exercise tolerance, slow voice, a low-pitched voice, periorbital Edema, delayed reflexes and

bradycardia. It can also cause hypertension, pericardial effusion, asymmetric septal myocardial hypertrophy,

myopathy, neuropathy, ataxia, anaemia, elevated cholesterol levels. Menstrual irregularities and bleeding

The standard treatment for hypothyroidism is thyroid hormone replacement therapy, usually in the form of

levothyroxine. This synthetic hormone is identical to T4 and helps restore normal hormone levels, alleviating

symptoms. The dosage of levothyroxine is individualized based on factors such as age, weight, severity of

hypothyroidism, and the presence of other health conditions. Regular monitoring of TSH levels is essential to

ensure the effectiveness of the treatment and to adjust the dosage as needed.

In ayurveda, there is no clearcut evidence of hypothyroidism, but based on its clinical presentation, it can be

correlated with different entities which one explained either as symptoms or diseases. There are many systems

which involves in the pathogenesis of hypothyroidism. The mixed signs and symptoms of all these systems leads

to a complex clinical picture of hypothyroidism. It can be considered under rasa pradoshaja vikara, galaganda,

kaphaja pandu, kaphavruta vata, kaphavataja shopha, medasvruta vata, amajeerna, bahudosha lakshana etc.

A female patient aged 42 years not a known case of hypertension and Diabetes mellitus was apparently healthy

before 6 years. She gradually started noticing tiredness, lethargy, drowsiness, hair fall, pain all over the body for

which she consulted a nearby clinic, while examining doctor noticed paleness in her eyes and nails. So, she was

advised to undergo blood ianvestigation (complete blood count). In that her haemoglobin percentage were low

so she was advised to take medications (details unknown). Patient continued the same for 3 months and had

symptomatic relief. After a year patient noticed similar complaints along with reduced appetite, heaviness of

body, muscle cramps in both calf muscles occasionally, irritability, mood swings.

So, she was asked to check her haemoglobin levels and it was low. So, to find out the cause for low haemoglobin

patient was asked to get her thyroid profile done. In that TSH levels were increased and doctor advised her to

This dosage continued for 2 years. In this period patient had symptomatic relief and there was reduction in all

symptoms. Then patient got conceived and she was continuing 50mcg dosage of T. Thyronorm (1-0-0 Empty

stomach) for first trimester. In her second trimester her thyroid profile was done and TSH levels were not in

control, so she was advised to take T. Thyronorm 75 mcg (1-0-0 in empty stomach). The same dosage continued

throughout her pregnancy and in later days also. Till May 2022 patient continued with the same dosage of T.

Thyronorm (1-0-0 in empty stomach). She wanted to quit T. Thyronorm and wanted an alternative for it. So, one

of her friends advised her to visit a folklore practician in Puttur. Patient consulted there and was advised few

medications, details of which are unknown to the patient and was asked to discontinue T. Thyronorm. Patient

took these medications for 4.5 months. For about 3 months patient couldn’t appreciate any difference in

symptoms neither increase nor decrease. But in the past 1-month patient started experiencing reduced appetite,

in abdomen. This is usually seen when patient skips her meals or any change in timings of food intake. She

complaints of incomplete evacuation of stools occasionally. Also, complaints of cramps in bilateral calf muscles

all the above complaints.

General Physical Examination

General condition: fair, built – Moderately built, Nourishment – Moderately nourished

Pulse: 70beats/min, Respiratory rate: 18 cycles/min, Blood pressure: 110/80 mm Hg, Temperature: 98°F Pallor:

Absent, Icterus: Absent, Lymphadenopathy: Absent, Cyanosis: Absent, Clubbing: absent, edema: absent

Height: 160cm, Weight: 65kgs BMI: 23.9kg/m2 Tongue: Coated.

Higher Mental Function Examination

• Appearance and behaviour: Intact

• Speech language: Intact

• Consciousness: Conscious

• Orientation: Well oriented to time, place, date

• Cranial nerves: Intact.

Respiratory System

• No surgical scars, rashes, redness seen.

• Bilateral symmetric chest movements on breathing.

• No local tenderness and palpable mass felt on palpation.

• Resonant notes heard on percussion, no abnormal bronchovesicular sounds heard on auscultation.

Gastrointestinal Tract

• Tongue – coated. No mouth ulcers. Oral hygiene maintained.

• Shape of abdomen: scaphoid Umbilicus: centrally placed, inverted

• Apex beat – palpable.

• Cardiac dullness heard on percussion.

• S1 S2 heard no added sounds or murmurs heard on auscultation.

Inspection

• Swelling – absent

• Scar – absent

• Nodules – absent

• Distended veins – absent

Palpation

Table No. 4.

TSH: 24.71

Hypothyroidism is considered as an endocrinal disorder, a condition wherein there is underproduction of the

thyroid hormones due to various structural or functional abnormalities resulting in clincal and biochemical

manifestation of the thyoid hormone deficiency in the target tissue of the hormone. Shedding light on the

pathogenesis of the disease based on ayurvedic principles, it becomes evident that kapha dosha is the chief culprit

along with vitiation of vata and pitta dosha. It can be interpreted as tridosha vitiation causing dysfunctioning of

agni i.e; agnimandhya at the level of koshta which further leads to dysfunctioning of agni at the level of dhatu

urdhwa or adha marga from the body is known as shodhana chikitsa. As there is bahudosha avastha and

symptoms resemble rasa pradoshaja vikara langhana chikitsa is the prime line of mangement which also includes

shodhana chikitsa. As there is involvement all tridoshas in this case, virechana karma has been selected.

In Bhela samhita in the context of doshabhedha upakrama, he has mentioned that when there is involvement of

all tridoshas virechana karma must be done.[5] Virechana karma without prior administration of vamana karma

may lead to grahani accadana leading to atisara, pravahika, gourava. In such cases, acharya sharangadhara has

mentioned the importance of deepana and pachana which must be adopted before virechana karma.[6]

In the present case sarvanga udwartana with triphala churna,[7] Yava churna[8] and kolakultadi churna[9]

followed by sarvanga abhyanga with yashtimadhu taila[10] and sarvanga bashpa sweda for 10 days along with

shamana oushadhi (Table No 2) were done prior to virechana karma. Udwartana is one of the rukshana

nourishment to the skin which reduces the dryness which is one of the symptoms seen in hypothyroidism.

Virechana karma was carried out. Snehapana with varunadi ghrita[12] and kalyanaka ghrita[13] was done until

attainment of samyak snigdha lakshanas (3days). Varunadi Ghrita has been mentioned in ashtanga hridaya and

sahasrayoga consists of drugs with tikta rasa pradhana, laghu ruksha guna and ushna veerya. It does kapha

medohara, agni deepaka and tridoshahara. Then in vishrama kala sarvanga abhyanga with yashtimadhu taila

followed by bashpa sweda was done for 3 days. Swedana is done after snehana as it liquifies the adhered morbid

material in the sookshma srotas of the shareera. Sarvanga abhyanga with yashtimadhu taila helps in mobilization

of accumulated muco-polysaccharides and fat metabolism. It contains ingredients such as yashtimadhu, Dhatri,

Tilataila and ksheera. Further it provides nourishment to the skin which reduces the dryness which is one of the

(100ml) was given for virechana karma. Patient had 22 vegas. She was advised samsarjana krama for 5 days.

Trivrut lehya was used as it is anapayitwa. It does sroto shodhana by dosha nirharana, agni deepana. It does

ruksha virechana, which facilitates in the removal of kapha sanchaya and induction of vata anulomana, deepana,

its secretions. Loha Bhasma and Abraka Bhasma and Tamra Bhasma all these are Balya, Ayushya, Vrishya and

Medhya, Datwagnivardhana, Malashodhaka and Pakwashyadushtinashka helps in building immunity in the

individual.

Kaklarakshaka Yoga

Kaklarakshaka yoga contains ingredients such as kanchanara, ashwagandha, guduchi, chitraka, guggulu, katuki.

It possesses katu, tikta, kashaya rasa, laghu ruksha guna. Does deepana, pachana and kapha pittahara.

Shilapravang

Shilapravang contains shuddha shilajatu, pravala bhasma, vanga bhasma, swarnamakshika bhasma, guduhi

satva, ashwagandha, and shatavari. Most of the drugs are having tikta, kashaya, madhura rasa. Does deepana,

kapha medohara, vatapitta hara and has rasayana actions.

Agni Deepaka, Tikta Rasa is Deepaka as well as Pachaka and hence it does Agni Deepana and Amapachana.

Hence in the pathogenesis of the hypothyroidism, where the Kapha and Vata are important Dosha, Rasa and

Meda are the most important Dushyas and the pathology is due to Dhatvagnimandhya, the drugs present in

Hamsapadyadi Kashaya seems too useful in combating the pathogenesis involved in the disease as well as

relieving the symptoms exhibited in this condition.

Pippalyasava[18]

Agnimandya and Amadosha are the important cause for the disease. Most of the drugs in Pippalyasava possesses