Analytical study on Hypothyroidism w.s.r to Adhishthanaantarani

Introduction 

Hypothyroidism is a disease which is caused by lack of effects of thyroid hormones in the body.It occurs in about 1 in 4000 newborns and is more common in women than men with a female-tomale ratio of 6:1.

Hypothyroidismis caused by any structural or functional derangement that interferes with the production of adequate levels of thyroid hormone. It can result from a defect anywhere in the Hypothalamic-Pituitary-Thyroid axis1 . Depending on whether Hypothyroidism arises from an intrinsic abnormality in the thyroid itself, or occurs as a result of pituitary or hypothalamic disease, it is divided into Primary and Secondary Hypothyroidism respectively2 . The common causes which are found responsible for development of hypothyroidism are Iodine deficiency; medications including rifampicin, phenytoin etc.; exposure of head and neck area to radiation; autoimmune disorders and idiopathic causes. Autoimmune disease (Hashimoto’s thyroiditis) and thyroid failure following 131 I or surgical treatment of thyrotoxicosis account for >90% of cases in regions where the population is not iodinedeficient. Less common causes include transient thyroiditis, inducement by amiodarone and dyshormonogenesis3 .

Hypothyroidism being a multisystem disease has a wide range of clinical presentations ranging from anorexia of GIT system to dry coarse skin and hair loss of integumentary system and even psychological symptoms like poor memory and concentration.This may be the reason that its diagnosis in the past might have been a clinical challenge, owing to the lack of biochemical and radiological technology.

Ayurveda has explained about the concept of ‘Srotas’which are the channels that are present all over the bodythrough which variousessence of the body named as Prana(breath), Anna (food & nutrients), Jala (water & bodily fluids), Dosha (basic elements), Dhatu (bodily tissues), Upadhatu (supportive tissues), Mala (bodily waste products) including Manas (mind) circulates, performing various functions in the body. Hence, these may be understood as the functioning systems of the body. A defect in any of these, leads to the manifestation ofa disease. Hypothyroidism can also be assumedto be caused by the defect in multiple Srotases, but the chief Srotaseswhich are affected are Rasavahaand MedovahaSrotas.

Hypothyroidism is basically a metabolic disorder. Ayurveda has described a similar concept for digestion and metabolism, called ‘Agni’. Agni is an entity which performs various functionsin the body such as digestion (Pachakagni), transformation (Bhutagni) and metabolism (Dhatvagni). Diminished state of Agni (Agnimandya) leads to decrease in the metabolic rate of the body. Hence, this may be inferred to be one of the causes of Hypothyroidism, especially Myxoedema.

The common clinical feature of Hypothyroidism is weight gain. In Ayurvedic classics, ‘Atisthula’ is described as one among the AstaNindita Purusha4 which are the disorders which seemed to be of hormonal derangement. Atisthula in this context which means excessive weight gain (obesity) seemed to be due to hormonal derangement. It is also considered as Medoroga by Madhavakara5 . Thus, the clinical presentations of Myxoedema are similar to Medoroga or Atisthoola.

Anotherconcept explained in Ayurvedic classicswhich has similar explanation to the pathogenesis of Hypothyroidism is ‘SahajaAsatmya’6 or ‘Virudha’. It is the innate opposing nature of the three Doshaamong themselves due to their opposite properties, thereby producing harm to the body. This can be assumed to be the Autoimmunity induced Hypothyroidism.

‘SamsargajaVyadhi’ is another concept described in Ayurveda under the umbrella of ‘Adhibhoutikavyadhi’7 which is the type of disease produced by infectious exogenous factor. This can be referred as infectious Acute Thyroiditis induced Hypothyroidism.

With this view, this study was made with an attempt to analyze the probable pathogenesis of Hypothyroidism as per the Ayurvedic perspective by following one of the tools for diagnosing an AnuktaVyadhi (unknown disease) i.eAdhishthanaantarani.

Discussion

AdhishtananiAntarani is the pathogenesis which occurs at respective site in order to produce a disease8 . In other words, it is the understanding of the Samprapti of a disease based on the action of the Doshasat a particular site. The Doshas although located in one place are likely to produce diseases at varioussites. For e.g. Vata Dosha when located at the Kantha region (neck) may cause Kanthotdhwamsa, Kasa, Swarabheda and Arochaka9 .

The Samprapti of Hypothyroidism can be framed under the two main pathogenesis. They areSantarpanajanya(hyper-nourished factors)and Apatarpanajanya (hypo-nourished factors)

I. SantarpanajanyaSamprapti of Hypothyroidism- Myxedema:

The etiological factors can be taken as those of Adibalajanya, Doshabalajanya, Vyadhihetu which are Santarpana in origin. These brings about increase in Kaphaand causes Agnimandya and this in turn leads to the accumulation of product called Ama. The formed Amaamalgamates with Rasa dhatuto produce Sama Rasa Dhatu. This Sama Rasa Dhatuspreads through the upper body channels (Urdhwaga Dhamanis) to apart/organ of the neck region called Shleshma Bhuvou10. Continued excitation of Kapha Dosha in this region vitiates the MedoDhatu(fat tissue).Dosha Dushya Sammurchana (amalgamation) at this juncture and Medodhatvagnimandya further leads to its abnormal accumulation thereby improperly nourished MedoDhatu results in increased size of Shleshma Bhuvouwhich is typically called as MedojaGalaganda.

The abnormal accumulation of MedoDhatu does not confine only in the region of the above said organ, but also starts to progress and reach all other sites wherever the spaces are available for getting accumulated, especially in the region of Sphik (buttocks), Stana(breasts) and Udara(abdomen). This implies the fact that Medoja Galaganda is a cause for Medoroga.

Medodhatwagnimandya due to vitiated Kaphaat the site of ShleshmaBhuvou causes both Sthanika and SarvadaihikaDushtiLakshana which could be studied in relation to the feature of Myxedema.

II. ApatarpanajanyaSamprapti of Hypothyroidism- Acute Thyroiditis:

The etiological factors which are responsible for Apatarpanajanya Samprapti of Hypothyroidism may be taken as those of Agantuja Nidana (exogenous etiological factors) such as Adhibhoutika viz. Vidyudashanikruta, Shastrakruta and Adhidaivika viz. Akasmika, Samsargaja which refers to Krimi (viral or bacterial infection). These brings about direct impact in the Rasayini (channels of circulation)and does the localizedvitiation (SthanikaDushti) at the site of Rasa(chyle) and Rakta (blood). The vitiated Vataand Pitta travel to the ShleshmaBhuvou through the Urdhvaga Siras and does vitiation of SthanikaKapha and hence establishing DoshaDushyaSammurchana. This further results in Dhatupaka and MedodhatvagniMandya at the level of Sthanata Medo Dhatu resulting in Acute Thyroiditis.

This stage simulates the status analogous explained as Acute Thyroiditis induced Hypothyroidism.

Thyroiditis is an inflammation of the thyroid gland, wherein one of the causative factors being viral or bacterial infection. Thyroiditis causes thyroid hormones to leak into the blood, raising their overall levels and leading to hyperthyroidism. After 1 to 2 months, this may develop into hypothyroidism11.

III. ApatarpanajanyaSamprapti of Hypothyroidism- Autoimmune Thyroiditis

‘Virudha’ is a unique concept described in Ayurveda. AcharyaVagbhata while explaining the concept of Ama has explained its understanding in several forms. Apart from the improper formation of Ahara rasa he has also mentioned about Mala Sanchaya which occurs in the form of stagnation of waste products in the body or in the form of Anyonyadosha Sammurchana, which is termed as Prathama Dosha Dushti.

The Doshas usually have the tendency of producing Virudhaproperties to one another, i.e. they have the tendency of harming each other. Although having this innate characteristic the Doshas do not produce such damage to the body in the equilibrium state. This is because of the SahajaSatmya to each other12. SahajaSatmya may be because, the Tridoshas are formed in the Garbha and developed together. Single celled human zygote in the womb develops into multicellular baby. The zygote is the mother cell to all these cells. These daughter cells recognize each other as sister cells. This recognition is said to be through the memory of surface antigens on each cell. Autoimmune disorder may be considered as a condition where the ‘SahajaSatmya’ of the Doshas is lost. Chakrapani further mentioned that though the Doshas do not oppose each other but due to ‘AdrishtaVashat’oppose each other and thereby producing harm to the body13. This ‘AdrishtaVashat’ may be an unexplainable triggering factor for Auto immunity. AsatmyaSevana is one such triggering factor. Once the auto immunity is initiated, the PrakupitaDoshas cause DhatuKshapana.

Hashimoto’s Thyroiditis is Autoimmune disease caused by a breakdown in self-tolerance to thyroid autoantigens. Its mechanismincludes the following: 1) Failure of self- tolerance 2) Induction of thyroid autoimmunity 3) Progressive destruction of thyrocytes14.

Samprapti Ghataka¹⁵

Dosha : Kapha, Vata

Dushya : Rasa, Medas

Srotas : Annavaha, Rasavaha, Medovaha,

Agni : Dhatvagnimandya

Udbhavasthana : Amashaya

Sancharasthana : Sarvashareera

Adhishthana : Sarvashareera, Gala

Rogamarga : Abhyantara, Bahya

VyadhiSwabhava : Chirakari

Conclusion

Hypothyroidism is a multiple systemic disorder. The diagnosis of the disease is challenging, as in the beginning stage it is asymptomatic or may present with vague symptoms like tiredness. Understanding the abnormality of the Dosha, Dushya Agni or the Srotas taking place, leading to manifestation of the Lakshana of the disease is essential for the early diagnosis and better treatment.