Hashimoto thyroiditis is an autoimmune disease in which thyroid cells are destroyed via cell and antibody- mediated immune processes. It is the most common cause of hypothyroidism in developed countries. In contrast, the most common cause of hypothyroidism worldwide is an inadequate dietary intake of iodine. The pathophysiology of Hashimoto thyroiditis involves the formation of antithyroid antibodies that attack the thyroid tissue, causing progressive fibrosis. The diagnosis can be challenging, and consequently, the condition is sometimes not diagnosed until late in the disease process. The most common laboratory findings demonstrate elevated thyroid-stimulating hormone (TSH) and low thyroxine (T4) levels, coupled with increased antithyroid peroxidase (anti-TPO) antibodies. Women will be affected more compared to males.
Early symptoms may include constipation, fatigue, dry skin, and weight gain. More advanced symptoms may include cold intolerance, decreased sweating, nerve deafness, peripheral neuropathy, decreased energy, depression, dementia, memory loss, muscle cramps, joint pain, hair loss, apnoea, menorrhagia, and pressure symptoms in the neck from goiter enlargement such as voice hoarseness. Muscle weakness and myopathy are important features.
In this article, we can discuss the case of Hashimoto thyroiditis presented in OPD.
On 03/07/2020, 63 yr. an old Brahmin lady with excessive burning sensation, severe gastritis, body pain and numbness, sleeplessness, LBA, difficult to bend forward, swelling around ankle joint B/L, knee joint pain B/L, approached me. She was also having severe fatigue. so I decided to palpate thyroid gland. On palpation a slightly swollen thyroid gland was felt.
Treatment Principle
Clinical presentation of patient was having more resemblance with gulma, hence gulmahara chikitsa along with vata anulomana was preferred. Hence, Sapthasaram Kashaya along with giloy satva was advised before food and patient were directed for investigations.
Considering gastritis and burning sensation guduchi (Tinospora cordifolia) satwa was given which acts as vata pitta hara. Bonniheal (a patent drug) was preferred as a vitamin D supplement.
Very next day 04/07/2020, patient forwarded her reports to me which shown as:
Total serum cholesterol 352 mg/dl
Tsh-150 iu/ml
We suggested further investigation.
06/07/2020
Thyroglobulin antibody-167.00u/ml
Tpo antibody 5.35iu/ml
Total T3-54ng/dl
Total t4-1.2mug/dl
Tsh-146.75iu/ml
Investigation report was clearly suggesting the case of Hashimoto thyroiditis and we suggested a detailed treatment plan for her. It includes, Thalam (application of medicine in the center of head) for 7days with Nimbamrutha eranda and Kachooradi churna which will help to regulate hormone imbalance. Medicines were also administered to reduce serum cholesterol. Kanchanara gulgulu along with Sapthasaram kashayam was advised considering the case as thyroiditis.
After 7 days, shiro abhyanga was started with vachadi kera mentioned in apachi chikitsa (A.H) to reduce inflammation. Along with that, Prishniparni root panakam was also advised to reduce cardiological risk. Vitamin D supplement was continued.
2nd visit-09/07/2020
On 09/07/2020, they came with both investigation results (results of 04th and 06th July 2020) for a second visit.
Major complaints like body pain were reduced. She can walk and stand better. Gas distention reduced. She revealed about severe stress.
Report of U.S.G NECK
Reports shown as diffusely enlarged hypoechoic hyper vascular thyroid gland, small nodule in Rt lobe of thyroid gland.
Considering reports of USG and mental stress of patient, some medicines were also added in prescription. Rudraksham powder along with khadira panam and milk was administered as medhya rasayana during bedtime. It will act as stress reliever and sleep regulator and helps to regulate hypothalamus pituitary thyroid axis. Other medicines like kanchanar guggulu and Prishniparni panaka etc. were continued. To reduce inflammation and for shrinkage of nodules, gayatrin ointment was applied locally over the thyroid gland externally.
3rd follow up- 23/07/2020
Most of the symptoms like fatigue and body pain were reduced and the patient was feeling lightness of the body. Considering vatapitta samaka effect as well as calcium supplement Pravala bhasma was started with honey. Giloy satva was needed to correct metabolism as well as vatapittahara, because in hypothyroidism often metabolism of protein, carbohydrates, and lipids will slow down.
As an immune modulator, stress reliever and nervine tonic, Ashwagandha churna with hot water was also prescribed. Combination of rudraksha and khadira was continued. For vata anulomana, Mahadhanwantharam tab was administered. Other medicines were also continued.
4th visit-23/08/2020
During 4th visit, TSH-99.23IU/ML and body pain reduced, Low back ache was seen occasionally. Since there is remarkable change, the medicines of last week were continued in the same dose and same time.
Besides TSH reduced- significant change in the inflammatory condition of thyroiditis was also seen and the condition of the patient was having better improvement.
5th visit-26/09/2020
Fbs-102mg/dl
- cholesterol-255mg/dl
Tsh-14.82muiu/ml
Considerable reduction was observed in test reports. Hence medicines were continued.
27/10/2020
TSH -2.5muIU/ML
External application of vachadi kera in the scalp was continued. Other medicines like Kanchanara guggulu, Rudraksha+khadira continued.
Remarkable change in thyroid level within a period of three months. All symptoms subsided. No fatigue, low back ache, gastritis and burning sensation, cholesterol level normal.
Advised for scanning and continuing medication. But She did not come up for follow-up.
After one year she came, and told me that since she stopped all medicines, again body pain started.
The results on her final visit were
TSH-2.5muIU/ML
Serum cholesterol-250 mg/dl.
Advised Liposem plus at night, and Ashtachoornam with butter milk after noon.
Hashimoto thyroiditis is an autoimmune thyroid
disorder associated with Hypothyroidism. In
Ayurveda only structural abnormalities of thyroid
glands are mentioned as Galaganda and Gandamala.
As no invasive methods/ scanning etc. were available at that time assessment of hormonal level was not considered. Only structural changes were taken into account.
Hypothyroidism is characterized by mandagni/ vishamagni and as such it affects the metabolism of carbohydrates, lipids, and protein. It is difficult to treat as it is an autoimmune disorder affecting the immune system of the body. So, the major logic that should be kept in mind was Vatanulomana and agni deepana along with relieving Stress and immunomodulators Medhya rasayanas were administered for hormonal control.
2 Comments
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The Above Article Is Very good and knowledgeable, Everybody Should Read it. Thanking You