An ayurvedic perspective of endocrinology vaidya narendra pendse
Transcript of An ayurvedic perspective of endocrinology vaidya narendra pendse
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!!