My friend Radha was a slim, sprightly woman with thick curls in her hair and spring in her step. She was in her early forties. I met her after a gap of three months. I was shocked to see a bloated Radha, lumbering along, her voice hoarse and thick and her hair thin and sparse. Immediately I asked her to bend her head and standing behind her felt the front part of her neck. As I suspected, there was a small lump. I asked her to swallow, and l could feel the lump moving up and down. I asked her to get her blood tested for thyroid hormones T3, T4 and TSH(thyroid stimulating hormone. The results showed that she was suffering from Primary Hypothyroidism with Goitre. She was treated with thyroxin, and within three months she became her former self.
A fifty-year-old patient of mine confessed to me, with tears in her eyes that she had become very impatient and irritated with her family. She would fly off the handle at the slightest provocation. She would feel hot and uncomfortable even in mid-winter. I asked her to extend her hands with palms downward. I placed a thin sheet of paper over her hands. The paper began to shake, transmitting the fine tremors of her hands. After undergoing blood tests for TSH and thyroid hormones, she was found to be suffering from Hyperthyroidism. She recovered well after appropriate treatment.
The thyroid hormones are secreted by a butterfly-shaped gland in the neck. It usually is neither visible nor can it be felt quickly. If it is slightly enlarged it can be palpated(felt) by the physician. If it is grossly enlarged it can be noticed as a lump in the neck. As the gland is situated close to the trachea and esophagus (windpipe and food pipe) pressure on them due to an enlarged gland can cause difficulty in breathing, difficulty in swallowing and a dry distinct cough. The thyroid gland secretes hormones thyroxine and calcitonin. Thyroxines are intimately associated with the metabolism of ingested carbohydrates, fats and proteins. Thyroid hormones also control metabolism of Vit.A, B- Complex Vitamins, Sodium, and Water. Calcitonin is involved in Calcium metabolism. As carbohydrate metabolism works under thyroid hormones, hypothyroidism can cause hyperglycemia and hyperthyroidism can cause hypoglycemia.
Derangement of fat metabolism can result in hyperlipidemia and weight gain in hypothyroidism and weight loss in hyperthyroidism. When protein metabolism is affected in hyperthyroidism, there is wasting of muscles(loss of muscle mass) and muscular weakness. Heart, which is a muscle is also affected. In hypothyroidism, the pulse is slow(bradycardia) and in hyperthyroidism, there is a racy pulse(tachycardia). Palpitations and arrhythmias (heart rhythm variations) can also occur.
Effects on the nervous system can cause slowing down of movements in hypothyroidism and excitability, irritability and restlessness in hyperthyroidism. Derangement of sodium and water metabolism result in kidney disorders.
When calcitonin levels are affected by hyperthyroidism density of bones is affected making them very fragile and prone to fractures.
In conjunction with the pituitary gland, the thyroid regulates physical and mental growth of a child. Hypothyroidism causes stunted growth and mental retardation(cretinism) in children. Liver which is a powerhouse of metabolic activity is affected in thyroid disorders. Thyroid hormones influence the release of hormones in testes and ovaries. So disorders of thyroid lead to menstrual disorders and infertility. As thyroid hormones regulate the release of prolactin, secretion of milk may be affected in nursing mothers in thyroid disorders.
Common disorders of the thyroid gland are primary hypothyroidism, hyperthyroidism, and goiter. Cancer of the thyroid gland is rare. Heredity, Autoimmune mechanisms, and iodine deficiency are implicated in thyroid disorders.
Goiter is enlargement of the thyroid gland. It may or may not be associated with thyroid hormone variations’ may be hard and nodular in hyper and soft and firm in hypo.
While patients suffer from sudden weight gain and voice changes in hypo, they suffer from sudden weight loss and eye changes like bulging eyes(exophthalmos) in hyper. While movements are slow in hypo, restlessness, irritability, and tremors characterize hyper. Pulse is slow in hypo whereas it is a racing pulse in hyperlink hypo there is cold intolerance, and in hyper, it is heat intolerance. Patients of hypo may suffer from depression and poor memory whereas hyper can suffer from irritability and aggressiveness. Extreme hypothyroidism can lead to myxoedema coma, and extreme hyper can lead to Thyrotoxic Crisis. Fortunately, they are rare and can be managed well by endocrinologists.
Tests for diagnosis include blood tests for total T3T4, freeT3T4, TSH, X-rays of neck, chest, MRI scan, Radioiodine Uptake Scan, Fine needle Aspiration etc. which are done as required to get an accurate picture of the disorder.
Treatment is supplementation with thyroxin in hypo. Immune suppressants and Radioiodine are employed in hyper. If Goitre is causing pressure symptoms, then surgery is undertaken. Swelling of goiter sometimes undergoes regression with medical therapy and rarely even without.
General good health maintenance regimes like exercise, low carb, low trans fat, and high protein diet, adequate intake of vitamins, calcium, minerals, and micronutrients and especially adequate intake of iodine of 140micro grams per day help to keep thyroid disorders at bay. Cabbage, cauliflower, broccoli, sweet potato, pearl millet, beans, and maize are best avoided in hypo. Seafood both veg .and nonveg. are advised. ln hyper, milk, ghee, melons, bananas, walnuts, and dates are advised. In Ayurveda, Sushruta describes swelling in the neck as Galaganda, which can be correlated with goiter. He describes three types of Galaganda: Vaataja, Kaphaja, Medojanya based on etiology. Based on the extension of the gland causing pressure symptoms and not being amenable to conservative treatment it is called Asadhya Galaganda. Perhaps surgery was not feasible then.
As we have seen in an earlier article on Endocrines, Panchakarma aims at restoring vitiated Kayani and dhatwagni-gastrointestinal digestion, absorption, and metabolism of ingested food- and tissue or cellular metabolism. Since thyroid disorders cause multiple metabolic derangements, Panchakarma is the treatment of choice. Preoperative procedures of Panchakarma include procedures like Snehana and Swedana(application and massage with medicated oils and then rubbing the body with a ball of cloth dipped in hot medicated oils or sweating in a steam chamber).Vamana(inducing vomiting), Virechana(giving laxatives)Anuvasana and Niruha Bastis. (introducing medicines through the rectum) and Nasya is the main Panchakarma procedures. Vishuddha Basti does local treatment for swelling also called Chakradhra. A dam of flour is built around the swelling, and medicated oil or kashayams are poured into the dam and left for some time. Shirodhara-pouring medicated oil like Eranda Taila on the spot on the head through a hole in a pot suspended over the head may help in stimulating cerebral circulation. This, in turn, may correct the hypothalamic-pituitary-thyroid axis. Nasya-instillation of medication into the nostrils is another effective method as the rich network of blood vessels in the nose are directly connected to the brain and again may act on the hypothalamus-pituitary-thyroid axis. Lepana- application of medicated paste to the swelling is also done.
Common herbs used in primary hypothyroidism are kanchanara, guggulu, gokshura, Brahmi, apamarga, ashwagandha, coconut oil etc. Shilajit and other rasoushadhis are also used. Kanchanaraguggulu, Varunadiquatha, Ashwagandharishta, Triphala, Mahayogarajaguggulu, Chandraprabhavati, Trivrit Kashaya are some of the effective formulations for thyroid disorders. The combination of Kanchanaraguggulu, Varunadiquatha and Trivrit Avaleha was found very effective in primary hypothyroidism in a research study conducted by Messers S.Panda and A, Kar.
Yoga is also found to help combat thyroid disorders. Sarvangasana, Matsyasana, Halasana, Suryanamaskara, and Naukasana are recommended. Pranayama or breath control can also help. Suryabhedana, Anulomana, Vilomana and Ujjayi forms of Pranayama are recommended.
Thyroid disorders develop insidiously, so one must be aware of the signs and symptoms. Annual thyroid screening can be done if there is family history of thyroid disorders. There is no cause for alarm as thyroid disorders can be tackled effectively.