Introduction

Subclinical hypothyroidism (SCH) is a disorder characterized by biochemical diagnosis with normal T3 and T4 but increased TSH levels with particular cardinal symptoms.^[1] Globally, 3% to 8% of the world population is affected by Subclinical hypothyroidism. It affects 2.4% to 3% male and 6% to 10% females worldwide.^[2] The prevalence is found to be high in women as compared to males and it increases with age.^[3] Most of the time, the condition Subclinical hypothyroidism is found to be asymptomatic.^[4] but can present with symptoms associated with hypothyroidism like weight gain, dry skin, hair loss, loss of appetite, muscular weakness, irregular periods, fatigue, cold intolerance, etc.^[5,6] Treatment for SCH if TSH levels >10 mIU/L, recommended by American Thyroid Association (ATA) & American Association of Clinical Endocrinology (AACE) is to begin with levothyroxine therapy.^[6] In Ayurveda, there is no direct correlation of SCH, but it can be correlated to Rasa Pradoshaja Vikara^[7], Kaphavrita-Udanavata^[8], based on clinical manifestations. The Nidana of Rasa Pradoshaja are intake of Atiguru Ahara, Atisnigdha Ahara, and Atimatra Ahara which leads to impairment in Agni, which further hampers the production of rasa.^[9] Overtime, this vitiation impairs the quality of rasa dhatu, ultimately disrupting balance of sapta dhatus. The treatment includes Nidanaparivarjana, langhana, shodana chikitsa, shamana chikitsa.

This case series includes 8 cases of Subclinical Hypothyroidism which was well managed with Ayurvedic intervention in terms of Shamana Aushadhis. This intervention was continued for a period of 42 days. The pre and post assessment was based on parameters like weight, BMI, waist circumference and hematological test i.e. Thyroid Function Test (TFT).

Case Series

Patients approaching Thyroid Specialty OPD of our hospital were screened for symptoms of Hypothyroidism, there were total 8 cases of all genders and mid aged group of Subclinical Hypothyroidism, some were pre-diagnosed and some were diagnosed by clinical symptomatically as well as heamatologically. There were number of cases attending OPD for Thyroid

Materials and Methods

The patients presented with features suggestive of Hypothyroidism were examined; clinical diagnosis was made and then confirmed with the help of Hematological investigation such as Thyroid profile test (TFT). After confirmation, patients with increased TSH value but normal values of T3 & T4 were considered for this case series. The demographic profile, associated symptoms such as weight gain, fatigue, dry skin & hairs, menorrhagia, weight gain, hoarseness of voice, periorbital oedema, bradycardia etc . if presented were taken into consideration for inclusion in this case series. Patients were informed of the objective and effects of their medicine. Patients who accepted to take medicine were prescribed treatment. Intervention period was of 42 days. Outcomes were also analyzed.

Mainly Kapha Dosha and Rasa Dhatu are involved in the pathogenesis of the Hypothyroidism disease. Sheeta Guna (~cold character) of Kapha Dosha is found to be increased in these cases. Hence Kaphahara (~kapha reducing), Ushna Virya (~hot potency) medicines are required. For this case Shigru (Moringa oleifera Linn.) Patra Churna (~powder of leaves) tablet was prepared and used for this case series. Shigru Patra is explained as ‘Medo (~fat of body), Apachi (~enlargement of gland of neck), Gulma (~lump in body), Ganda (~enlargement of thyroid gland), Vrana (~wound), Hareta (conquer)’ in Bhavaprakasha Nighantu. That is why Shigru Patra Churna is selected for this case series.

Table 2: Shows Samprapti Ghataka of disease

Study Design

Shigru Patra Churna tablet (500 mg each) two

predominantly impact energy metabolism. Numerous conditions, including obesity, neurological symptoms, cardiovascular disease, type-2 diabetes mellitus, and infertility, are linked to hypothyroidism. Although the term ‘Hypothyroidism’ is not described in Ayurvedic Samhitas, the condition might be mostly associated with activity of Agni. Ayurvedic texts have described thirteen types of Agni, with the most fundamental being the Jatharagni (~digestive fire present in abdomen). Their equilibrium is contingent upon both Ahara & Vihara.^[10]

As was evident in the above instances, habitual eating of Guru, Madhur (~sweet), Sheet, and Drava Ahara (~liquid food article) along with inactivity or less activity, lack of exercise, Shodhana etc. Due to this Kapha Dosha will get vitiated and causes Agnimandya, which leads to formation of Ama, and Dhatwagni Mandyata, resulting into Rasadhatu Vikruti.

Chikitsa (~treatment) for such diseases should focus on Agni, which corrects Dhatwagni Mandhya and Jatharagni. It is necessary for the implementation of Srotorodha (~blockage of channels), Kapha-Vata Shaman, and Medohara (~reducing fat) line of treatment.

Shigru Patra has Katu, Tikta Rasa, Ushna Virya, Katu Vipaka and Kapha-Vata Hara Karma; which will help for Agni Deepana and Shoshana when administration done on empty stomach. The word Shigru itself says ‘Shinoti Taikshnyat Shigru’ which means drug which possess Tikshnata. One more synonym is Mochaka which says ‘Munchati Rogat Mochak’ means which eradicates all diseases.

Katu Rasa has ‘Sneha-Meda-Kleda Shoshana’ Guna^[11] which is helpful in such cases where in obesity due to Hypothyroidism there will be accumulation of excessive subcutaneous fat is seen. Also Shigru acts as Apatarpanakara due to it’s Ruksha, Ushna and Laghu Guna. Katu Rasa also does Srotomukha Shodhana which is very much useful in such cases.

Glucosinolate, quercetin & glucomoringin are some of the phytochemicals present in Moringa leaf which has anti-inflammatory property. Kaempferol is one more phytochemical which is strong antioxidant which helps in regulation of oxidative stress, which is one of the factor for progression of mild to severe form.^[12]