A Randomized Comparative Clinical Study To Evaluate The Efficacy of Laghuvaishvanarchurna And *Dhanyanagarkwath In The Management Of Dhatvagnimandhya wsr To Subclinical Hypothyroidism

INTRODUCTION

Hypothyroidism is a very common disease in human beings. It is a clinical syndrome due to deficiency of thyroid hormones, which result in a generalized slowing down of metabolic process. Hypothyroidism is one of the major disease of thyroid gland involving most of the system of the body. Subclinical hypothyroidism is defined as mildly reduced function of thyroid gland with either minimal symptoms or no symptoms of hypothyroidism having an elevated serum TSH (Thyroid stimulating hormone) level and normal concentration of free T3(Triiodothyronine)FT3, free T4(Thyroxine)FT4, T3 and T4. Although this definition is based on biochemical criteria. It is well recognized that some individual patients may present with symptoms and sign of hypothyroidism. It is confirmed by laboratory diagnosis of serum levels of elevated TSH and normal FT4 and T3. Antithyroid antibodies can be detected in 80% of patient with subclinical hypothyroidism. Positive thyroid antibody titers suggest autoimmune

thyroid disease. Euthyroid patient with positive thyroid peroxidase antibody (TPO) titers have high chance of developing hypothyroidism. It is usually primary disease of thyroid but may be secondary due to disturbances of hypothalamic-pituitary axis.

In Ayurveda, there is no exact mentioned of the disease but it could be correlated with Kaphaja Shotha, Kaphaja Galganda and Rasaja Pradoshaja vikar described by the Acharya. In the Charak Samhita eight type of nindita purusha have been described which can be taken as functional disorders of endocrine. As per the concept of Agni, normalcy of Agni is must for body function rhythmicity. In Ayurveda texts it is mentioned that metabolic process is controlled by Jatharagni, Bhutagni, Dhatvagni. So, the cause of disease is alteration in metabolic activity which according to Ayurveda, is vitiation of Dhatvagni. Agnimandhya at any level due to kaphakara nidan results increased dhatugat mala sanchay, resulting in srotorodh causing compromised dhatu saras, leading to both physical and mental features in subclinical hypothyroidism.

LITERATURE REVIEW -

In Ayurveda there is no direct mention of hypothyroidism. But on the basis of its clinical presentation, it can be correlated with different entities which one explained either as symptoms or disease. So it’s difficult to give a single Ayurvedic term for it. There are many systems which involves in the pathogenesis of hypothyroidism.

On the basis of Ayurvedic principles we can understand the pathology of hypothyroidism. We find that it is basically caused due to dysfunctioning of the Jatharagni (Agnimandhya), which is further leads to Bhutagni and Dhatvagni vitiation, ultimately causing pathological condition of hypothyroidism. This agnimandhya results in formation of abnormal Ras dhatu i.e. Aama lakshna and the symptoms seen in subclinical hypothyroidism are similar.

DRUGS REVIEW:

LAGHU VAISHVANAR CHURNA - The classical preparation is mentioned in Yog Ratnakar.

Its content drugs Saindhav lavan, Haritaki, Pippali, Chitrak mool.

DHANYA-NAGAR KWATH -The classical preparation is mentioned in Yog Ratnakar. Its content drugs Shunthi, Dhanya.

Routine Investigations :

Investigations will be done before starting the therapy and at completion of trial. Assessment of the therapy will be done by evaluating their value before and after completion of trial.

â–ª Haematological investigation-

CBC

ESR

Blood sugar-F and PP,

â–ª Biochemical investigation-

LFT,

KFT,

Urine - routine & microscopy,

Other investigation like ECG, Chest x- ray, USG, CT-scan, MRI, TMT, would be done if necessary.

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Specific Investigations :

1. T3 (Tri-iodothyronine)

2. T4 (Thyroxine)

3. TSH (Thyroid-stimulating hormone)

4. Anti-TPO (Thyroid peroxidase antibody)

PARAMETERS FOR ASSESSMENT OF STUDY OUTCOMES

PRIMARY END POINT

Improvement in subjective symptoms. SECONDARY END POINT

Change in Thyroid profile before and after the study