Hypothyroidism a state of deficient thyroid hormone action in peripheral tissues that depend on thyroid hormone for its normal cellular function 1. Primary hypothyroidism refers to thyroid failure that results from disease of thyroid gland itself 2. Central hypothyroidism is a term used for thyroid failure caused by hypothalamic or pituitary disorders that result in deficient central production of thyro-tropin-releasing hormone (TRH) and/or thyroid-stimulating hormone 3, 4 Peripheral hypothyroidism is a diverse group of disorders in which thyroid hormone secretion is normal or increased but thyroid hormone action in peripheral tissues is impaired. Overt hypothyroidism describes moderate to severe thyroid failure resulting in high serum TSH level with low serum concentration of total thyroxine. Sub clinical hypothyroidism refers to mild thyroid failure in which serum TSH levels are moderately increased, but total serum thyroxine T4 remain within the normal limit 5.

Reported clinical features of hypothyroidism have changed over years. The “classic” features described in 1948 include weakness (99%), dry skin (97%), coarse skin (97%), lethargy (91%), slow speech (91%), puffy eyelids (90%), cold intolerance (89%), decreased sweating (89%), cold skin (83%), thick tongue (82%), facial oedema (79%), coarse hair (76%), pale skin (67%), impaired memory (66%), constipation (61%), weight gain (59%), hair loss (57%), lip-pallor (57%), dyspnoea (55%), oedema (55%), hoarseness (55%), anorexia (45%), nervousness(35%), menorrhagia (32%), palpitation (31%), impaired hearing (30%), precordial pain (25%) 6.

Clinical features described in later literature (1997) include dry skin (76%), cold intolerance (64%), coarse skin (60%), puffy eyelids (60%), decreased sweating (54%), weight gain (54%), paraesthesia (52%), cold skin (50%), constipation (48%), slow movements (36%), hoarseness (34%), impaired learning (22%) 7.

According to recent literature studies (2014), reported clinical symptoms of hypothyroidism include- fatigue (81 %), dry skin (63%), shortness of breath (51%), mood liability (46%), constipation (39%), globus expansion (36%), palpitations (35%), restlessness (33%), hair-loss (30%), dysphagia (29%), wheezing (27%) and vertigo (24%). Thyroid hormone has important action on organs and tissues throughout the body, due to which the sign and symptoms of hypothyroidism are multi systemic 8.

After evaluating the clinical text in Ayurveda it reveals that Hypothyroidism is due to anomaly of Jathragni (~agni that acts on the food in gastro-intestinal tract to digest it), Bhutagni (~act on the corresponding substrate based on panchabhautika composition to make them homologous to that of bodily constituents) and Dhatwagni (~metabolic factor located in dhatu/consist of seven types of agni responsible for transformation of one dhatu into another) with vitiation of Kapha and Vata dosha and Medo dhatu dushti (~deformity in adipose tissue and other lipids in body) 9.

A 22-years- old female patient, a B.A.M.S student is suffering from sthaulya (~weight gain/obesity), duarbalya (~weakness/debility), twak rukshata (~dryness of skin), kesh patana (~falling of hairs), gradual loss of hairs coupled with development of facial hairs, puffiness specially around eyes, mood swings and behavioural changes, impaired memory and difficulty in thinking, emotional depression, drowsiness, headache, amalapitta (~hyperacidity), bhinna swara (~Hoarseness of voice) and lethargy. These complaints have gradually progressed. She also has a history of constipation on and off. Patient was diagnosed with hypothyroidism 3 years ago and has been taking Allopathic treatment with no relief. She was taking Thyronorm 75 mcg daily. With all these complaints she came to our O.P.D for Ayurvedic treatment and to get rid of her daily pill.

The patient was non diabetic, normotensive with no history of allergy to any allergen, addiction, surgical intervention. There was no linked past history and no history of Pulmonary tuberculosis, Bronchial asthma, Epilepsy or any other serious illness. She had no family history of hypothyroidism.

Upon clinical examination of patient, the patient had a pulse rate of 68/min, blood pressure 124/76 mm of Hg, Axillary temperature 97.8ºF, SpO₂ 98, Respiratory rate 16/min. Her weight was 68 kg and height were 5 feet. There were no signs of Pallor, icterus, cyanosis, clubbing, lymphadenopathy, discolouration, or pigmentation. Puffiness was present around eyes and on face. Her skin texture was rough and hairs were coarse. Coarse facial hairs were also present over the chin. Cardiovascular examination revealed no abnormality with normal S₁ and S₂ sound and no added murmur. Respiratory examination revealed bilaterally equal air entry with no abnormality. There were no signs and symptoms of organomegaly in abdomen. Abdomen was soft and non-tender.

Ashtasthana pariksha (~eight folds examination of patient)- It reveals that her Nadi (~pulse rate) was 68/min and was kapha-vataja in nature, Mala (~stool/excreta) was normal and was without Ama dosha (~anything that exists in a state of incomplete transformation), Mutra (~urine) was Prakrut (~normal) in quantity and was without burning sensation, her Jihwa (~tongue) was Aam yukta/Sama (~coated). Her Shabda (~voice/speech) was hoarse and was not Spashta (~not Clear), her Sparsha (~tactile examination) was Ruksha (~dryness of skin) leading to Khara sparsha (~rough texture of skin/dryness of skin), her Driga (~eye and eyes sight) was normal, her Akriti (~body stature) was Uttama (~excellent).

Dashvidha pariksha (~Ten folds examination of patient)- On thorough clinical examination it was found that patient was of kapha-vattaja prakruti (~physical constitution), was of Madhyama (~moderate) (i) Sara (~eight state of excellence of tissue elements) and Madhyama Samhanana (~compactness of tissues or organs). Her Ahara shakti (~power of intake and digestion of food) was Madhyama, Saatmya (~homologation/habituation) and Pramana (~measurement of the body constituents) were Uttam (~excellent). She had Madhyama Vyayama shakti (~power of performing exercise). Vikruti (~morbidity) was of Kapha-vata dosha and Rasa (primary product of digested food) and medovaha strotas dushti (~deformity in adipose tissue and other lipids in body). She was of Uttam satva (~psychic condition). Her Vaya pariksha (determination of age) revealed her to be in Vardhamana dhatu phase of Balyavastha (~here the tissues of body are in state of growth and maturation).

The patient’s thyroid profile was not normal, with a TSH level of 6.81 uIU/ml even after taking Thyroxine hormone replacement of 75 mcg daily empty stomach. Diagnosis was made by her thyroid profile and symptoms suggesting of hypothyroidism.

After complete assessment of Dosha-dhatu involved in the pathology of disease, treatment with Kanchanar guggulu 10, 11 with Varunadi kashaya 12, Mrituanjya rasa with Hamsapadiadi kashaya and Madhusnuhi rasayana 13 was advised for first one month (Table 1). Subsequently, the patient was carefully observed for one month. With the decrease in her TSH level and improvement in her symptoms, her allopathic medicine was reduced to 50 mcg on first follow up. The treatment plan was then revised and Arogyavardhini vati 14, Chandraprabha vati 15, Shudha Gandhaka, Kanchanar guggulu and Madhusnuhi rasayana was advised for next two months (Table 1).

After three months, her allopathic medicine Thyronorm was reduced to 25 mcg, and the revised treatment plant consisting of Arogyavardhini vati and Kanchanar guggulu was given for one more month (Table 1). On her fourth follow up, her TSH level was within normal limit, and her symptoms had completely disappeared. As a result, both her allopathic medicine as well as ayurvedic medicine was fully stopped. And patient was advised to follow pathya ahara vihara (~diet and lifestyle having beneficial effect over the body and mind) along with yogasana (~body posture that is performed to benefit body and mind) for her overall well- being and maintenance of general health.

There was significant reduction in severity of all symptoms in subsequent follow up (Table 2).

The patient was advised to undergo investigations of T3, T4 and TSH after each month of treatment. Before starting the treatment her T3, T4 and TSH values were 90.0 ng/dl, 4.10 ug/dl and 6.81 uIU/ml, respectively. At first follow up her T3, T4 and TSH values were 76.00 ng/dl, 7.93 ug/dl and 0.968 uIU/ml, respectively, while at second follow up her T3, T4 and TSH values were 90.0 ng/dl, 11.96 ug/dl and 0.555 uIU/ml, respectively. At end of treatment her T3, T4 and TSH values were 94.0 ng/dl, 6.64 ug/dl and 0.073 uIU/ml, respectively.

At the end of four months, most off her symptoms disappeared. She lost 5 kg in during whole treatment schedule. Her facial hairs remained same, but her skin texture had improved. Puffiness of her face had healed after treatment, and she began to feel more energetic after first month of treatment.

No side effects or toxic effects were noted throughout the treatment schedule. Her TSH level was maintained within the normal range with ayurvedic medicines and her allopathic medicine was gradually decreased. After 4 months, the symptoms were no longer observed, and the patient appeared clinically normal. She was fully satisfied with Ayurvedic treatment.

Hypothyroidism occurs due to disbalance of Kapha and Vata dosha coupled with Agnimandhya (~depressed/weak state of Agni) which leads to production of Ama (anything that exist in a state of incomplete transformation leading to production of toxins at any stage of metabolism). Ama is produced due to Jathragnimandhya (~Decreased digestive power) which further causes vitiation of Bhutagni (~decrease digestive power at the level of micro and microcirculation) leading to derangement of Dhatwagni causing Rasa and Meda dhatu dushti. Approach is made not only to remove Ama at the level of thyroid gland but also to overcome the blockage caused by Ama at Strotas level in peripheral tissues. Mrituanjaya rasa possess the property of Deepana-pachana (~digestion and metabolism enhancing) hence it helps in Sanshaman (~pacifying therapy) of Ama and improvement of Jatharagni. Arogyavardhini vati and Shuddha Gandhaka helps in digestion of Ama and improves Dhatwagni to prevent Rasa and Medo dhatu dushti. Kanchanar guggulu was given to strengthen the endocrine gland and to reduce excessive growth of the body. It is well-known for its Galganda (~Goitre) and Gandmalanashana (~Glandular enlargement, Lymphadenitis) property. Hamsapadiadi Kashaya helps to regulate thyroid gland and prevent thyroid enlargement. Varunadi kashaya is Kapha-medhoghana and helps in improving Agni (all the factor responsible for digestion and metabolism). It prevents weight gain and puffiness of face and hand. Madhusnuhi and Chandraprabha vati were administered as Rasayana (~medicine use to improve health and longevity) drugs to strengthen normal functioning of the body. Rasayana drugs helps in increasing Vyadhikshamatvam (~resisting power of the body/Immunity to fight diseases) of the body.

This case report contributes to enhancing the effectiveness of oral Ayurvedic treatment for Hypothyroidism without any unfavourable effects. No signs of toxic effects and reversal of symptoms were observed during the follow up. Hence, there is need to conduct this study on larger sample size to find its effectiveness in larger population. Patient-reported complete disappearance of symptoms. Before starting the treatment, she was taking allopathic medicines daily. However, after receiving ayurvedic treatment, she no longer required allopathic medicines as all her vital parameters were within the normal range. Furthermore, after the discontinuing Ayurvedic treatment, the patient did not require any medicine and no unfavourable outcomes or toxic effects were noted.