Efficacy of Shodhana Karma in the management of hypothyroidism in children -...

[Full title: Efficacy of Shodhana Karma in the management of hypothyroidism in children - A Case Report]

CASE REPORT March 2022 Journal of Ayurveda and Integrated Medical Sciences | March 2022 | Vol. 7 | Issue 2 125 Efficacy of Shodhana Karma in the management of hypothyroidism in children - A Case Report Rutu Patel Professor, Department of Kaumarabhritya, J. S. Ayurveda Mahavidyalaya, Nadiad, Gujarat, India. I NTRODUCTION Thyroid gland disorders are the most common endocrine problems in childhood [1] In children, thyroid hormone helps to ensure that growth and development occurs normally. Hypothyroidism can be present at birth (congenital hypothyroidism) or it can develop later in childhood as acquired. Autoimmune thyroiditis is the most common cause of acquired hypothyroidism in children, and adolescents and usually develops after the first few years of life. In autoimmune thyroiditis, the immune system mistakes thyroid gland cells for invaders and attacks them, leading to inflammation of the thyroid. Gradually, the Address for correspondence: Dr. Rutu Patel Professor, Department of Kaumarabhritya, J. S. Ayurveda Mahavidyalaya, Nadiad, Gujarat, India. E-mail: vdrutu 8888@gmail.com Submission Date: 12/01/2022 Accepted Date: 24/02/2022 Access this article online Quick Response Code Website: www.jaims.in Published by Maharshi Charaka Ayurveda Organization, Vijayapur, Karnataka (Regd) under the license CC-by-NC-SA inflammation damages the thyroid gland, leading to decline in thyroid hormone levels. Once the levels drop below the normal level, the pituitary gland notices the hypothyroidism and responds by making more TSH increase thyroid hormone levels [2] Clinical features include weight gain, slow growth, cold intolerance, constipation and deteriorating school performance. Children with hypothyroidism (elevated TSH and low T 4 levels) are treated by replacing the amount of hormone that the child’s own thyroid can no longer make. The goal is to bring the T 4 and TSH back to the normal range and restore the body’s normal functions (replacement therapy). In Ayurveda, autoimmune disease can be compared with Dhatugata Ama with vitiation of Tridosha. Shodhana Karma is required for Samprapti Vighatana . In this case study, Virechana Karma with Basti Chikitsa has been applied. C ASE R EPORT This female child age 15-year came to Kaumarbhritya OPD, P.D.Patel Ayurveda hospital, Nadiad with complaints of continuous gaining of weight, laziness, poor school performance and confirmed diagnosis of A B S T R A C T Disorders of thyroid glands are the most common endocrinal problems of childhood. Thyroid hormone helps to ensure that growth and development occurs normally. Autoimmune thyroiditis is the most common cause of acquired hypothyroidism in children and adolescents and usually develops after the first few years of life. In Ayurveda, autoimmune disease can be compared with Dhatugata Ama with vitiation of Tridosha. This study aimed to access the efficacy of Ayurvedic management including Shodhana Karma in hypothyroidism in pediatric age. It is a single case study A 15-year female child has already been diagnosed with hypothyroidism since 6 years proceed to the Ayurvedic hospital. And she was treated with Virechana Karma followed by Basti with internal medications. Laboratory investigations were carried out after treatment with satisfactory outcome. Key words: Hypothyroidism, Ayurveda, Shodhana Karma, Virechana Karma, Basti Karma, Shamana Chikitsa.

Rutu Patel. Efficacy of Shodhana Karma in the management of hypothyroidism in children ISSN: 2456-3110 CASE REPORT March 2022 Journal of Ayurveda and Integrated Medical Sciences | March 2022 | Vol. 7 | Issue 2 126 hypothyroidism from 6 years. There was no significant past history of any other chronic illness. In family history her father was suffering from hypothyroidism and is on treatment since long time. Thyronorm tablet was started in the dose of 25 mcg per day at that time. Mild improvement was observed in TSH level. She was moderately responding to thyronorm for a period of next 2 years. After 2 years, thyroid stimulating hormone level persistently remained elevated even after thyronorm (25 mcg) per day was continued. TSH level increased to 57.06 microU/ml (normal: 0.35 to 5.55 microU/ml), when she visited this hospital. And the dose of thyronorm was increased up to 75 mcg per day. Despite increased dose of thyronorm the patient’s TSH did not respond. The parents brought her here for Ayurvedic treatment. Management: Virechana Karma and Niruha Basti were planned, as the patient’s age was not suitable for the Vamana Karma A. Virechana Karma 1 Snehapana with Panchatikta Ghrita was started in dose of 40 ml twice a day on 1 st day, in increasing order with addition of 15 ml each day till Sneha Siddhi Lakshana were obtained. Sneha Siddhi Lakshana was found at 85 ml twice a day on the 4 th day. 2 After Samyaka Snehapana, Sarvanda Abhyanga with Narayana Taila and Bashpa Swedana were performed for 3 days. 3 Virechana Karma was planned with Dindayal Churna [3] - 4 gm. mixed with Eranda Sneha - 40 ml. The patient got 25 Virechana Vega. 4 Sansarjana Krama was followed for 2 days. B. After the completion of Virechana Karma , the following treatment was given for 3 weeks. 1 Varunadi Kwatha ( Sharangadhar Samhita ) [4] - 40 ml, twice a day on empty stomach. 2 Triphala Guggulu [5] - 2 tablets, thrice a day, after meal. 3 Navayasa Lauha [6] - 1 gm., twice a day with Madhu . 4 Niruha Basti with Triphala Kwath (250 ml) was administered for two weeks. 5 Patient was continued on light diet and Mung Dal, rice and boiled vegetables during the whole therapy. She also continued thyronorm tablet (75 mcg) per day during whole therapy. R ESULTS Initial (26-05-18) After 1 month (05-06-18) Normal Values Weight 86.2 kg 78 kg - T 3 0.43 ng/ml 1.13 ng/ml 0.6 - 1.80 ng/ml T 4 3.2 mcg/dl 10.8 mcg/dl 4.5 - 10.9 mcg/dl TSH 57.06 microU/ml 7.76 microU/ml 0.35 - 5.55 microU/ml Her body weight was 74 kg at the time of follow up (23- 07-18). DISCUSSION Hypothyroidism is mostly caused by chronic autoimmune thyroiditis, and was observed more commonly in girls. Autoimmune process can consider under the broad heading of Dhatugata Ama with vitiation of Tridosha . Shodhana Karma is required for Samprapti Vighatana . Virechana Karma leads to Srotasa Shuddhi , removal of Sanga from Srotasa and is responsible for Dhatvagni Deepana . Niruha Basti leads to Kapha Shodhana and Vatanulomanam . Srotoshuddhi helps in removing Aavarana from receptors which helps in proper functioning of them and improve metabolism. Varunadi Kwath, Triphala Guggulu and Navayasa Lauha were used as Shamana Chikitsa . All these three Aushadhi Yoga are Kaphavata Shamaka . CONCLUSION This case study showed that Panchkarma therapy is necessary for the management of Hypothyroidism. It has provided not only in the symptomatic relief but

Rutu Patel. Efficacy of Shodhana Karma in the management of hypothyroidism in children ISSN: 2456-3110 CASE REPORT March 2022 Journal of Ayurveda and Integrated Medical Sciences | March 2022 | Vol. 7 | Issue 2 127 also restore the normal level of hormone. Dose of levothyroxine will be reduced slowly along with Ayurvedic treatment. REFERENCES 1 Krishna MVG, Kumar Devendra. Hutchison’s Paediatrics. New Delhi: Jaypee Brothers. 2 nd Edition, 2012;p 439. 2 Hypothyroidism in children and adolescents. American thyroid association. 2017. Available from: https://www.thyroid.org/hypothyroidism-childrenadolescents/ 3 Shastri Shankar Daji Pade, Vyas Harikrushna Bhagavanlal, Aryabhishak. Ahmedabad: Sastu Sahitya. 6 th Edition, 1982;p 438. 4 G Prabhakar Rao. Sharangdhar Samhita. New Delhi, Chaukhambha Publications. 2013;p 98. 5 G Prabhakar Rao. Sharangdhar Samhita. New Delhi, Chaukhambha Publications. 2013;p 150. 6 G Prabhakar Rao. Sharangdhar Samhita. New Delhi, Chaukhambha Publications. 2013;p 138. ******************************* How to cite this article: Rutu Patel. Efficacy of Shodhana Karma in the management of hypothyroidism in children - A Case Report. J Ayurveda Integr Med Sci 2022;2:125-127. Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2022 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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Ayurveda, Niruhabasti, Triphalaguggulu, Bastikarman, Adolescent, Mung dal, Family history, Light diet, Constipation, Internal medication, Boiled vegetables, Shamanacikitsa, Autoimmune disease, Vamana Karma, Shodhana Karma, Virechana Karma, Case report, Weight gain, Triphala Kwath, Panchkarma therapy, Samprapti Vighatana, Sarvanga Abhyanga, Srotoshuddhi, Hypothyroidism, Varunadi Kwatha, Sneha Siddhi Lakshana, Bashpa swedana, Sansarjana Krama, Thyroid hormone, Levothyroxine, Autoimmune thyroiditis, TSH level, Varunadi Kwath, School Performance, Vitiation of tridosha, Navayasalauha, Eranda Sneha, Kaphavata shamaka, VIRECHANA VEGA, Cold intolerance, Slow growth, Poor school performance, Kapha Shodhana.