An ayurvedic perspective of endocrinology vaidya narendra pendse

doctorspendse@gmail.com

SALUTATIONS TO MY MENTORS

1. VD. B.P. NANAL,2. VD. V.B.MHAISKAR,3. VD. R.B.GOGTE, 4. VD. VILAS M. NANAL,5. VD. RAMESH M. NANAL,6. VD. M.V.KOLHATKAR,7. VD. Y.G.JOSHI & MANY OTHERS

AN AYURVEDIC PERSPECTIVE OF

ENDOCRINE DISORDERS

NARENDRA PENDSE MD ( AYURVEDA )

AYURVEDA COLLEGE, AKURDI30 SEPT, 2015

ENDOCRINE DISORDERS

AYURVEDIC PERSPECTIVE :

GENETIC ENDOCRINE DISEASES

GENETIC ENDOCRINE DISEASESCAUSES NOTED IN AYURVEDA

1. DAU-HRUD VIMANAJ : SU.SH. 3 /18 दौहृदवि�माननात् 

कुब्जं कुणि�ं खञं्ज 

जडं वामनं  वि�कृताक्षमनक्षं �ा नारी सुतं जनयवित

CAUSES OF GENETIC ENDOCRINE DISORDERS

OPINION OF DALHANA : डल्ह�:

 तत्र कुब्जादि�ष्ववयवसमु�ायेन्द्रि��याधि�ष्ठानजो

�ोषो �ौहृ�विवमाननजविनतो यथाशास्त्रमूह्यः||१८|| 

GENETIC ENDOCRINE DISEASESIN AYURVEDA

SUSHRUT SHARIR. 3 /18

जडं - dumb, idiotic

वामनं -  A dwarf, pigmy

APTE’S SANSKRIT ENGLISH DICTIONARY

वामनं – age 9 years

GENETIC ENDOCRINE DISORDERS : CAUSES

2. MOTHER’S IMPROPER DIET : CHARAK SHARIR 8 / 21

मधुरविनत्या प्रमेवि*णं मूकमवितसू्थलं �ा,

कटुकविनत्या दुर्ब0लमल्पशुक्रमनपत्यं �ा

GENETIC ENDOCRINE DISORDERS : CAUSES

3. MOTHER’S BEHAVIOUR : CHARAK SHARIR 8 / 21

व्य�ायशीला दु�'पुषमह्रीकं स्त्रैणं �ा

स्तै्रणं – a. ( a male ) behaving like a female, b. ( a male ) enjoys being with females

GENETIC ENDOCRINE DISORDERS : CAUSES

4. MOTHER’S MENTAL STATUS : CHARAK SHARIR 8 / 21

अभि-ध्यात्री  परोपताविपनमीर्ष्युंयु2स्त्रैणं �ा CHAKRAPANI – अभि8ध्यात्री मनसा �ो*णशीला|

�ो*णशीला – malicious minded, plotting against

NEW CONCEPTS

THYROID HORMONE TRANSPORTERS

‘NATURE REVIEWS ENDOCRINOLOGY’

MAY, 2015

“THYROID HORMONE TRANSPORTERS –

FUNCTIONS AND CLINICAL IMPLICATIONS”

JUAN BERNAL et al,

CHALLENGES IN TREATMENT

MONOTHERAPY VS COMBINATION THERAPY IN

HYPOTHYROIDISM ‘JOURNAL OF CLINICAL

ENDOCRINOLOGY & METABOLISM’ Thyroxine-triiodothyronine combination

therapy versus thyroxine monotherapy for clinical hypothyroidism: Meta-analysis of randomized controlled trials. 

J Clin Endocrinol Metab. 2006;91:2592–2599. Grozinsky et al.

CONCLUSION Implications for practice and research : “Given the conclusive evidence,

monotherapy with T 4 should remain the standard treatment for hypothyroidism.

It is doubtful whether further trials evaluating combination therapy are needed because the chances that the accumulated evidence will change are low.”

SHARING EXPERIENCES

IN

THE TREATMENT OF

THYROID DISORDERS

HYPOTHYROIDISM

HYPOTHYROIDISM : CLINICAL MANIFESTATION - 1

1. FATIGUE

2. INCREASED SENSITIVITY TO COLD

3. CONSTIPATION

4. DRY SKIN

5. UNEXPLAINED WEIGHT GAIN

HYPOTHYROIDISM : CLINICAL MANIFESTATION - 2

6. PUFFY FACE

7. HOARSENESS

8. MUSCLE WEAKNESS

9. ELEVATED BLOOD CHOLESTEROL LEVEL

10. MUSCLE ACHES

HYPOTHYROIDISM : CLINICAL MANIFESTATION - 3

11. MUSCLE TENDERNESS 12. MUSCLE STIFFNESS

13. JOINT PAIN

14. JOINT STIFFNESS

15. JOINT SWELLING

HYPOTHYROIDISM : CLINICAL MANIFESTATION - 4

16. HEAVIER THAN NORMAL OR IRREGULAR MENSTRUAL PERIODS

17. HAIR THINNING

18. BRADYCARDIA

19. DEPRESSION

20. IMPAIRED MEMORY

DIAGNOSIS OF ‘THYROID DISORDERS’ ACCORDING TO

AYURVEDA

1. SWATANTRA

2. PARATANTRA

CLASSIFICATION OF THYROID DISORDERS

  1. SANTARPANOTHA,( USUALLY HYPO )

2. APATARPANOTHA ( USUALLY HYPER )

DIAGNOSIS OF ‘HYPOTHYROIDISM’ AS SWATANTRA VYADHI

1. KAPHAVRUT VAT,

2. KAPHAVRUT VYANA,

3. KAPHAVRUT UDANA,

4. KAPHAVRUT SAMANA

DIAGNOSIS OF ‘HYPOTHYROIDISM’ AS SWATANTRA VYADHI

5. SHOTHA – ( KAPHAJ / KAPHA- VATAJ)

6. RAKTAPRADOSHAJA VIKARAS

7. GALGANDA

KAPHAVRUT VAT

शैत्यगौर�शूलाविन कट्�ाद्युपशयोऽधिधकम्||६२|| 

लङ्घनायासरूक्षोर्ष्युं�काधिमता च कफा�ृते| 

CHARAK. CHI. 28 / 62-63

KAPHAVRUT VYANA

गुरुता स�'गात्रा�ां स�'सन्ध्यस्थिDजा रुजः||२२८|| 

व्याने कफा�ृते लिलङं्ग गवितसङ्गस्तथाऽधिधकः | 

CHARAK. CHI. 28 / 228-229

KAPHAVRUT UDANA

आ�ृते शे्लर्ष्युंम�ोदाने �ै�र्ण्यंय2 �ाक्स्�रग्रहः||२२४|| 

दौर्ब'ल्यं गुरुगात्रत्�मरुलिचश्चोपजायते| 

CHARAK. CHI. 28 / 224-225

KAPHAVRUT SAMANA

अस्�ेदो �धिSमान्द्यं च लोमहष'स्तथै� च||२२६|| 

कफा�ृते समाने स्याद्गात्रा�ां चावितशीतता| 

CHARAK. CHI. 28 / 226-227

DIAGNOSIS OF ‘HYPOTHYROIDISM’ AS PARATANTRA VYADHI

1. AJEERNA,

2. GRAHANIPRADOSHA ( KAPHA/KV)

3. AGNIMANDYA,

4. KRIMIKOSHTHA,

5. PANDU,

HYPOTHYROIDISM : SAMPRAPTI FACTORS - 1

1. DOSHA : VATA – primarily VYANA, SAMANA,UDANA

PITTA- primarily PACHAK, SADHAKA, RANJAKA

KAPHA- primarily KLEDAKA / SLESHAKA / TARPAKA

HYPOTHYROIDISM : SAMPRAPTI FACTORS - 2

 2. DHATU : all 7 but primarily RASA, RAKTA, MEDA, MAMSA, ASTHI,

***OJA

HYPOTHYROIDISM : SAMPRAPTI FACTORS – 3 A

 3. SROTASA : primarily RASA, RAKTA, MEDA, MAMSA, ASTHI,

HYPOTHYROIDISM : SAMPRAPTI FACTORS – 3 B

 3. SROTASA : &

OJAVAHA, ANNAVAHA

SLESHMAVAHA,

UDAKAVAHA,

MARMAVAHA

HYPOTHYROIDISM : SAMPRAPTI FACTORS - 4

 4. AGNI : all 3 especially DHATVAGNI – ESP. RASA, RAKTA,

MEDOVAHA

BHUTAGNI : PARTHIV & JALA

HYPOTHYROIDISM : SAMPRAPTI FACTORS - 5

 5. AAM : usually PRESENT**

HYPOTHYROIDISM : SAMPRAPTI FACTORS - 6

 6. UPADHATU : RAJA & SNAYU

HYPOTHYROIDISM : SAMPRAPTI FACTORS - 8

 8. GUNAS : vitiation 1. SNIGDHA,2. MANDA,3. PICCHIL,4. GURU,5. SANDRA,6. STHIRA, with **RUKSHA

HYPOTHYROIDISM HETUS - 1

1. VIRUDH – AHAARA,

2. ABHISHYANDI AHAARA,

3. KRUMI – KOSHTHATA,

4. ATI / AKALI– NIDRA SEVAN,OR NIDRA – VIPARYAYA, 5. SOYA

HYPOTHYROIDISM HETUS - 2

** KULAJA : SROTO – DUSHTI ( previous 3 generations )

1. RASAVAHA,( EG. SHOTHA)

2. MEDOVAHA,( EG. MADHUMEHA, STHOULYA)

3. RAKTAVAHA ( EG. VATRAKTA )

HYPOTHYROIDISM SAMPRAPTI

NIJA: DUSHTIHETU-SEVANA RASA / MEDA /SLESHMA

ANYA DHATU / SROTO / MARMA DUSHTI

HYPOTHYROIDISM CHIKITSA

1. SHAMANA 2. SHODHANA

HYPOTHYROIDISM CHIKITSA

1. SHAMANA LANGHANA : i. AT THE BEGINNING,

ii. REPEATEDLY

HYPOTHYROIDISM CHIKITSA

LANGHANA : AS

LAGHWASHANA / SIDDHA AHAARA

I. SIDDHA KSHIRA : RASONA, SUNTHI, TRIKATU, BHALLATAKA,

HYPOTHYROIDISM SHAMANA CHIKITSA - 1

CHOORNA : 1. HINGU - VACHADI,

2. YOGARAJA,

3. PATHYADI, 4. HARITAKI + PUNARNAVA

HYPOTHYROIDISM SHAMANA CHIKITSA - 2

GUGGUL : 1. KANCHNARA,

2. PUNARNAVADI,

3. YOGRAJ, 4. KAISHOR

HYPOTHYROIDISM SHAMANA CHIKITSA - 3

GHRIT : 1. MAHAPANCHGAVYA,

2. BHALLATAK / KSHIRA SHATPALA,

3. SUKUMARA, 4. VARUNADI,

HYPOTHYROIDISM SHAMANA CHIKITSA - 4

BHASMA : 1. ABHRAKA ( PLAIN / SHATPUTI ),

2. LOHA ( PLAIN / SHATPUTI ),

3. HEERAKA,

4. KASIS

HYPOTHYROIDISM SHAMANA CHIKITSA - 5

RASKALPA : 1. SINDOOR – RAS / MALLA, 2. YOGENDRA RAS,

3. HEMAGARBHA RAS,

HYPOTHYROIDISM SHAMANA CHIKITSA - 6

KALPAS :

1. PUNARNAVA MANDOOR, 2. AROGYAVARDHINI RAS,

3. CHANDRAPRABHA RAS,

4. SANJEEVANI VATI

HYPOTHYROIDISM SHAMANA CHIKITSA - 7

LEHAS :

1. PUNARNAVA MANDOOR, 2. KALYANAKA AVALEHA,

3. DASHMOOLA HARITAKI ,

HYPOTHYROIDISM SHODHANA CHIKITSA

1. BASTI

2. VAMANA

HYPOTHYROIDISM : USE OF PRAMATHI DRAVYAS

विनज�ीयV� यद ्द्रव्यं स्रोतोभ्यः दोषसंचयम्। विनरस्यवित प्रमालिथ स्यात् तद्यथा मरिरचं �चा। - Sharangadhara Samhita

प्रमालिथ-ा�ात् लीनमल उल्लेखनसामर्थ्याया0त्। - Ayurveda Rasayana commentary

PRAMATHI DRAVYAS

1. TRIKATU,

2. PIPPALI ( 64 ),

3. ‘UTKLESHANA’ BASTI

AS : LEENA DOSHA : UTKLESHANA

उत्+स्थिक्^श् (to agitate, to excite) उत्क्^ेशन (agitation, excitement)

उत्क्^ेश्य - प्रकोप्य। Dalhana Su. S. 20

उस्थित्क्^ष्ट स्थानात् चधिलतः। Arunadutta

उत्क्^ेशो �ोषाणां स्थानात् चलनम्। Arunadutta

AS : LEENA DOSHA : UTKLESHANA BASTI

दद्यात् उत्क्^ेशनं पू�2 मध्ये दोषहरं पुनः। पश्र्चात् संशमनीयं च दद्यात् र्बस्तिस्तं वि�चक्ष�ः।

एरर्ण्यंडर्बीजं मधुकं विपप्प^ी सैन्ध�ं �चा। हपुषाफ^कल्कश्र्च र्बस्तिस्तः उत्क्^ेशनः स्मृतः। - Shushruta Chi. 38/91, 92

UTKLESHANA BASTI DRAVYA• Eranadabeeja- Bhedaneeya, adhobhagahara

• Hapusha- Deepana

• Pippali- Yogavahi, urdhvabhagahara, deepaneeya

• Vacha- Pramathi, virechana, lekhaneeya

• Yashtimadhu- Chardana, vamanopaga

• Madanaphala- Urdhvabhagahara, vamaka

• Saindhava- Chardana

NIROOHA BASTI IN HYPOTHYROIDISM

** AT ONSET & LATER TOO. 1. UTKLESHANA,

2. BRIHAT ERANDAMOOLADI,

3. DASHMOOLA,

ANUVASANA BASTI IN HYPOTHYROIDISM

** USUALLY LATER. 1. UTKLESHANA,

2. SAHACHARADI,

3. RASNADI,

VAMANA IN HYPOTHYROIDISM

SNEHAPANA WITH :

1. TILA TAILAM,

2. PREVIOUS GHRITAS IN SUKUMARA RUGNAS

VAMANA IN HYPOTHYROIDISM

1. MADANAPHALA PIPPALI CHOORNA,

2. MADANA + VACHA + YASHTI,

PANARTHA : PANCHATIKTAKA KWATH

VAMANA IN HYPOTHYROIDISM

HYPERTHYROIDISM

HYPERTHYROIDISM : CLINICAL MANIFESTATION - 1

1. SUDDEN WEIGHT LOSS ( EVEN WHEN APPETITE AND AMOUNT AND TYPE OF FOOD REMAIN THE SAME OR INCREASE )

2. TACHYCARDIA — COMMONLY MORE THAN 100 BEATS A MINUTE OR ARRHYTHMIA OR PALPITATIONS

HYPERTHYROIDISM : CLINICAL MANIFESTATION - 2

3. INCREASED APPETITE

4. NERVOUSNESS, ANXIETY AND IRRITABILITY

5. FINE TREMOR

6. SWEATING

HYPERTHYROIDISM : CLINICAL MANIFESTATION - 3

7. CHANGES IN MENSTRUAL PATTERNS

8. INCREASED SENSITIVITY TO HEAT

9. CHANGES IN BOWEL PATTERNS, ESPECIALLY MORE FREQUENT BOWEL MOVEMENTS

HYPERTHYROIDISM : CLINICAL MANIFESTATION - 4

10. AN ENLARGED THYROID GLAND (GOITER),

11. FATIGUE,

12. MUSCLE WEAKNESS

HYPERTHYROIDISM : CLINICAL MANIFESTATION - 5

13. SLEEP DISTURBANCES

14. SKIN THINNING

15. FINE, BRITTLE HAIR

DIAGNOSIS OF ‘THYROID DISORDERS’ ACCORDING TO

AYURVEDA

1. SWATANTRA

2. PARATANTRA

CLASSIFICATION OF THYROID DISORDERS

  1. SANTARPANOTHA,( USUALLY HYPO )

2. APATARPANOTHA ( USUALLY HYPER )

DIAGNOSIS OF ‘HYPERTHYROIDISM’ AS SWATANTRA VYADHI

1. PITTAVRUT VAT,

2. PITTAVRUT VYANA,

3. PITTAVRUT PRANA - UDANA,

4. PITTAVRUT SAMANA

DIAGNOSIS OF ‘HYPERTHYROIDISM’ AS SWATANTRA VYADHI

5. RAKTAPITTA

6. RAKTAPRADOSHAJA VIKARAS

7. PANDU

8. KLAMA

PITTAVRUT VAT

लिलङं्ग विपत्ता�ृते दाहस्तृर्ष्युं�ा शूलं भ्रमस्तमः||६१ 

कट्�म्लल��ोर्ष्युं�ैश्च वि�दाहः शीतकाधिमता|  CHARAK. CHI. 28 / 61-62

PITTAVRUT VYANA

व्याने विपत्ता�ृते तु स्याद्दाहः स�ा'ङ्गगः क्लमः|| 

गात्रवि�क्षेपसङ्गश्च ससन्तापः स�ेदनः| 

CHARAK. CHI. 28 / 227-228

PITTAVRUT PRANA

मूर्च्छाा' दाहो भ्रमः शूलं वि�दाहःशीतकाधिमता||२२१|| 

छद'नं च वि�दग्धस्य प्रा�े विपत्तसमा�ृते|

CHARAK. CHI. 28 / 221-222

PITTAVRUT UDANA

मूर्च्छाा'द्याविन च रूपाभि� दाहो नाभ्युरसः क्लमः||

ओजोभ्रंशश्च सादश्चाप्युदाने विपत्तसं�ृते|   CHARAK. CHI. 28 / 223-224

PITTAVRUT SAMANA

अवितस्�ेदस्तृषा दाहो मूर्च्छाा' चारुलिचरे� च||२२५|| 

विपत्ता�ृते समाने स्यादुपघातस्तथोर्ष्युंम�ः|  CHARAK. CHI. 28 / 225-226

PITTAVRUT APANA

हारिरद्रमूत्र�च'स्त्�ं तापश्च गुदमेढ्रयोः||२२९|| 

लिलङं्ग विपत्ता�ृतेऽपाने रजसश्चावित�त'नम्| 

CHARAK. CHI. 28 / 229-230

DIAGNOSIS OF ‘HYPERTHYROIDISM’ AS PARATANTRA VYADHI - 1

1. GRAHANIPRADOSHA ( VATPITTAJA / V / P)

2. JWARA ( UPADRAV )

3. AMLAPITTA,

DIAGNOSIS OF ‘HYPERTHYROIDISM’ AS PARATANTRA VYADHI - 2

5. VIDAGDHAJEERNA

6. KRIMIKOSHTHA,

7. PANDU,

8. MADHUMEHA ( ASAMYAK CHIKITSA )

HYPERTHYROIDISM : SAMPRAPTI FACTORS - 1

1. DOSHA : VATA – ( ALL 5 SUB TYPES )

PITTA- ( ALL 5 SUB TYPES )

KAPHA- primarily BODHAKA / KLEDAKA / SLESHAKA / TARPAKA

HYPERTHYROIDISM : SAMPRAPTI FACTORS - 2

 2. DHATU : all 7 but primarily RAKTA, RASA, MEDA, MAJJA,

MAMSA, ASTHI,

***OJA

HYPERTHYROIDISM : SAMPRAPTI FACTORS – 3 A

 3. SROTASA : primarily RAKTA, RASA, MEDA, MAJJA,

MAMSA, SHUKRA / ARTAVA

HYPERTHYROIDISM : SAMPRAPTI FACTORS – 3 B

 3. SROTASA : &

OJAVAHA, ANNAVAHA

SLESHMAVAHA,

UDAKAVAHA,

MARMAVAHA

HYPERTHYROIDISM : SAMPRAPTI FACTORS - 4

 4. AGNI : all 3 especially DHATVAGNI – ESP. RAKTA, RASA,

MEDOVAHA

BHUTAGNI : TEJ, AKASH, VAYU & JALA

HYPERTHYROIDISM : SAMPRAPTI FACTORS - 5

 5. AAM : usually PRESENT ***

HYPERTHYROIDISM : SAMPRAPTI FACTORS - 6

 6. UPADHATU : RAJA & SIRA

HYPERTHYROIDISM : SAMPRAPTI FACTORS - 8

 8. GUNAS : vitiation 1. USHNA,2. LAGHU,3. TIKSHNA,4. SARA,5. SOOKSHMA,6. DRAVA with **RUKSHA

HYPERTHYROID HETUS - 1

1. VIRUDH – AHAARA,

2. VIDAAHI AHAARA,

3. KRUMI – KOSHTHATA,

HYPERTHYROID HETUS - 2

4. ATI / AKALI– NIDRA SEVAN,OR NIDRA – VIPARYAYA,

5. ATI VYAVAYA / VYAYAMA,

6. TIKSHNA / PRAMAATHI DRAVYA SEVAN eg. CHILLIES, MADYA

HYPERTHYROID SAMPRAPTI

NIJA: DUSHTIHETU-SEVAN RAKTA / RAS / PITTA/VAT

ANYA DHATU / SROTO / MARMA DUSHTI

HYPERTHYROID CHIKITSA

1. SHAMANA 2. SHODHANA

HYPERTHYROID CHIKITSA

1. SHAMANA A. MRUDU LANGHANA,

B. SANTARPANA AHAAR,

C. SNIGHDHA AHAAR

HYPERTHYROID SHAMANA CHIKITSA - 1

CHOORNA : 1. AVIPATTIKAR,

2. GUDUCHYADI,

HYPERTHYROID SHAMANA CHIKITSA - 2

GHRIT : 1. SHATAVARYADI,

2. DADIMAADI,

3. MAHA KALYANAKA, 4. AMRIT PRASH,

HYPERTHYROID SHAMANA CHIKITSA - 3

BHASMA : 1. ABHRAKA ( PLAIN / SHATPUTI ),

2. MAUKTIK,

3. SUVARNAMAKSHIK,

4. PRAVAL,

HYPERTHYROID SHAMANA CHIKITSA - 4

BHASMA : 5. TRUN KANTA MANI PISHTI,

HYPERTHYROID SHAMANA CHIKITSA - 5

RASKALPA : 1. SUVARNA SOOTSHEKHAR, 2. RAUPYA SUVARNA SOOTSHEKHAR,

3. PRAVAL PANCHAMRIT,

4. BRIHAT VATA CHINTAMANI RAS

HYPERTHYROID SHODHANA CHIKITSA

1. VIRECHANA,

2. BASTI

3. ** ABHYANGA & SHIRODHARA

HYPERTHYROID VIRECHANA CHIKITSA

1. SNEHAPANA WITH PREVIOUS

GHRITAS

2. TRIVRIT LEHA FOR VIRECHANA

ANUVASANA BASTI IN HYPERTHYROIDISM

1. SIDDHA GHRIT BASTI WITH DADIMAADI etc,

2. KSHIRA BALA TAILAM,

3. MADHUYASHTYADI TAILAM

YAPANA BASTI IN HYPERTHYROIDISM

1. BALADI,

2. MUSTADI,

3. GUDUCHI / YASHTIMADHU / KIRATA SIDDHA KSHIR

THE SHIRODHARA MODALITY

PRIMARY ACTION ON SHIRA & INDIRECTLY ON ENDOCRINE

AREAS FOR RESEARCH

&

PROBABLE AYURVEDIC

INSIGHTS

SUBCLINICAL HYPOTHYROIDISM

DEFINITION: A SERUM TSH CONCENTRATION BELOW THE STATISTICALLY DEFINED LOWER LIMIT OF THE REFERENCE RANGE WHEN SERUM T4 AND T3 CONCENTRATIONS ARE WITHIN THEIR REFERENCE RANGES.

SUBCLINICAL HYPOTHYROIDISM

Subclinical Thyroid Disease : Scientific Review and Guidelines for Diagnosis and Management

Martin I. Surks et al;

JAMA January 14, 2004, Vol. 291

SUBCLINICAL HYPOTHYROIDISM

SUBCLINICAL HYPOTHYROIDISM

AMONG PATIENTS WITH UNTREATED SUBCLINICAL HYPOTHYROIDISM, THERE IS NO SINGLE LEVEL OF SERUM TSH AT WHICH CLINICAL ACTION IS ALWAYS EITHER INDICATED OR CONTRAINDICATED. AS THE SERUM TSH CONCENTRATION INCREASES ABOVE 10 MIU/L,

SUBCLINICAL HYPOTHYROIDISM

HOWEVER, THE BASIS FOR INITIATING TREATMENT IS MORE COMPELLING AS THE SERUM TSH CONCENTRATION INCREASES ABOVE 10 MIU/L, HOWEVER, THE BASIS FOR INITIATING TREATMENT IS MORE COMPELLING

SUBCLINICAL HYPOTHYROIDISM

CLINICAL CONTEXT IS PARTICULARLY IMPORTANT. THIS OPINION REFLECTS CLINICAL EXPERIENCE AND JUDGMENT AS WELL AS THE LITERATURE THAT SUGGESTS IMPROVEMENT IN SYMPTOMS AND POSSIBLE LOWERING OF LDL CHOLESTEROL.

SUBCLINICAL HYPOTHYROIDISM

THERE ARE NO STUDIES THAT DEMONSTRATE DECREASED MORBIDITY OR MORTALITY WITH TREATMENT.

SUBCLINICAL HYPOTHYROIDISM

THE POTENTIAL RISKS OF THERAPY ARE LIMITED TO THE DEVELOPMENT OF SUBCLINICAL HYPERTHYROIDISM, WHICH MAY OCCUR IN 14% TO 21% OF INDIVIDUALS TREATED WITH LEVOTHYROXINE.

THYROID TESTS : INDIAN REFERENCE RANGE

CLIN BIOCHEM. 2013 MAR;46(4-5):341-5 REFERENCE RANGE OF THYROID

FUNCTION (FT3, FT4 AND TSH) AMONG INDIAN ADULTS.

MARWAHA RK et al

NATURE REVIEWS ENDOCRINOLOGY

“THE TSH UPPER REFERENCE LIMIT: WHERE ARE WE AT?”

PETER LAURBERG et al,

pg. 232-239, APRIL 2011

REGION SPECIFIC REFERENCE SCALES - 1

‘REGIONAL REFERENCE VALUES OF THYROID GLAND VOLUME IN TURKISH ADULTS’,

ERTAN et al, ‘SRP ARH CELOK LEK’. 2015 MAR-APR;143(3-4):141-145,

REGION SPECIFIC REFERENCE SCALES - 2

“LOCAL REFERENCE RANGES OF THYROID VOLUME IN SUDANESE NORMAL SUBJECTS USING ULTRASOUND”

YOUSEF M et al, JOURNAL OF THYROID RESEARCH,

SEPTEMBER, 2011;

REGION SPECIFIC REFERENCE SCALES - 3

"COMPARATIVE ULTRASOUND MEASUREMENT OF NORMAL THYROID GLAND DIMENSIONS IN SCHOOL AGED CHILDREN IN OUR LOCAL ENVIRONMENT"

MARCHIE TT et al,

NIGERIAN JOURNAL OF CLINICAL PRACTISE,

2012 JUL-SEP;

REGION SPECIFIC REFERENCE SCALES - 4

"INTERPRETATION OF NORMATIVE THYROID VOLUMES IN CHILDREN AND ADOLESCENTS: IS THERE A NEED FOR A MULTIVARIATE MODEL?"

SVENSSON J et al,

THYROID. 2004 JUL; pg. 536-43.

Figure 2 Age‑specific TSH values (log‑scaled) at diagnosis in 578 patients with spontaneous (autoimmune) hypothyroidism

Laurberg, P. et al. (2011) The TSH upper reference limit: where are we at? Nat. Rev. Endocrinol. doi:10.1038/nrendo.2011.13

GUT FLORA IN THYROIDITIS

“DOES THE GUT MICROBIOTA TRIGGER HASHIMOTO’S THYROIDITIS?”

KOUKI MORI et al.,

JR SENDAI HOSPITAL & TOHOKU UNIVERSITY GRADUATE

SCHOOL OF MEDICINE, SENDAI, 980-8508, JAPAN

GUT FLORA IN THYROIDITIS

Conclusion “ A growing body of evidence has

demonstrated that environmental factors including infection are critical in triggering Hashimoto’s thyroiditis in genetically predisposed individuals……

GUT FLORA IN THYROIDITIS Conclusion…..Not only pathogens but also intestinal

symbiotic microorganisms can influence extra-intestinal immune responses, and thus dysbiosis in the gut might lead to the loss of tolerance to self-antigens including thyroglobulin and the autoimmunity that underlies Hashimoto’s thyroiditis.”

SHIFT DUTY IN ENDOCRINE DISORDERS

SHIFT DUTY IN ENDOCRINE DISORDERS

‘INTERNATIONAL JOURNAL OF ENDOCRINOLOGY’, VOLUME. 2015,

REVIEW ARTICLE BY M. A. Ulhôa et al, Department of Medicine, UNEC, Nossa

Senhora das Grac¸as, Unity II, 35300-345 Caratinga, MG, Brazil

FINAL REMARKS

‘MEAL TIMES AND CONTENT OF MEAL,

AS WELL AS THE PRACTICE OF PHYSICAL

EXERCISE, SHOULD SUIT WORK

HOURS…

FINAL REMARKS

FURTHERMORE, STRATEGIES FOR

AVOIDING STRESSORS IN THE WORK

ENVIRONMENT AND CARE OVER THE

QUALITY OF SLEEP MIGHT MINIMIZE

PROBLEMS RESULTING FROM SHIFT WORK.’

AS WELL AS

MY PATIENTS &

STUDENTS!

LET’S GO…..

DHANYAVAAD!!