What is thyroid disease?
Thyroid disease is a disorder that affects the thyroid gland. Sometimes the body produces too much or too little thyroid hormone. Thyroid hormones regulate metabolism—the way the body uses energy—and affect nearly every organ in the body. Too much thyroid hormone is called hyperthyroidism and can cause many of the body’s functions to speed up. Too little thyroid hormone is called hypothyroidism and can cause many of the body’s functions to slow down.
Thyroid hormone plays a critical role during pregnancy both in the development of a healthy baby and in maintaining the health of the mother.
Women with thyroid problems can have a healthy pregnancy and protect their fetuses’ health by learning about pregnancy’s effect on the thyroid, keeping current on their thyroid function testing, and taking the required medications.
Being pregnant can be a stress test for the thyroid. The size of the gland increases by 10%. Production of thyroid hormones T3 and T4 increases by about 50%. As a result, the normal thyroid-stimulating hormone (TSH) level during pregnancy is lower than the normal no pregnancy level.
Ayurvedic Perspective on Hypothyroidism - Galaganda
There is no direct mention of the thyroid gland in Ayurveda. But a disease by the name galaganda is mentioned in various samhitas. The earliest description of neck swelling is found in the atharvaveda by the name apachi (a non-suppurative swelling in the neck, axilla, or groin). Charaka first described the disease as one of the 20 varieties of sleshma (kaphaja) vikaras (disease). Sushruta explicitly wrote that out of seven layers of the skin, the sixth layer, Rohini, is galaganda rogadhistana-(Su.Sa.IV/4). In the nidana sthana he describes galaganda as two encapsulated small or big swellings in the anterior angle of the neck, which hang like a scrotum (Su.Ni.XI), whereas Charaka describes galaganda as solitary swelling (Ch.Ch.XI).
The etiological factors in galaganda include climatic conditions, water supply, dietary conditions and other surroundings. Sushruta stated that rivers flowing towards east might give rise to the occurrence of galaganda. Bhela states that galaganda is more common in prachya desa (eastern part) of the country. Harita samhitakara described the role of dustambu (contaminated water) in the precipitation of galaganda. Kashyapa samhita says that any part of the country which is cold, damp, with densely grown long trees, water stagnation and heavy rains may promote the development of galaganda.
From the above descriptions it is tempting to associate galaganda can be with goiter (abnormal swelling of the thyroid gland) or some type of neck tumor, where thyroid functions may or may not be compromised. But hypothyroidism is not just a localized disease. It has many symptoms related to many systems of the body. None of these manifestations are mentioned in the ancient texts. Thus it is probably inaccurate to draw a parallel between hypothyroidism and galaganda.
Recommendations for Testing for Thyroid Disease During Pregnancy
The new recommendations for TSH levels during pregnancy are the following:
- First trimester: less than 2.5 with a range of 0.1-2.5
- Second trimester: 0.2-3.0
- Third trimester: 0.3-3.0.
If the TSH is greater than 2.5 at any time during pregnancy, T4 levels should be checked to determine whether the hypothyroidism is overt or subclinical.
If T4 is low, the diagnosis is overt hypothyroidism, which can impair the infant's neurocognitive development. There are also increased risks for premature birth, low birth weight, and miscarriage. Overt hypothyroidism must be treated.
If TSH is high and the T4 is normal, the diagnosis is subclinical hypothyroidism. In this case, the next step is to check for antithyroid peroxidase antibodies. Women who are antibody positive should be treated. The effect of subclinical hypothyroidism on fetal neurocognitive development is not clear. But one large study showed lower IQ tests in the children of untreated women.
Treatment is necessary when TSH is 10 or more, regardless of the T4 level. In addition, TSH should be monitored every 4 weeks during the first 20 weeks of gestation, then once again between 26 and 32 weeks.
Conception in Women With Hypothyroidism
What about women with hypothyroidism who want to get pregnant? It should be stressed that the need for extra thyroid hormone occurs as early as the first to 6 weeks of pregnancy. The new guidelines recommend that before trying to conceive, clinicians should adjust the patient's medication dose with a TSH goal of less than 2.5. Also, patients should increase their thyroid replacement dose by 25%-30% as soon as they miss a period or have a positive home pregnancy test. About 2 to 3% of pregnancies are reported with subclinical hypothyroidism, whereas occurrences of overt hypothyroidism are 0.3 to 0.5%. Dosage often requires fine-tuning, so continue to check TSH every 4 weeks during the first half of pregnancy.
Causes
The most common cause of hypothyroidism is the autoimmune disorder known as Hashimoto’s thyroiditis. In this condition, the body mistakenly attacks the thyroid gland cells, leaving the thyroid without enough cells and enzymes to make enough thyroid hormone.
Symptoms
Symptoms of hypothyroidism, such as extreme tiredness and weight gain, may be easily confused with normal symptoms of pregnancy. Other symptoms include:
- Constipation
- Difficulty concentrating or memory problems
- Sensitivity to cold temperatures
- Muscle cramps
Diagnosis
The diagnosis of hypothyroidism can be difficult, since the symptoms can often be confused with pregnancy symptoms. The doctor may examine you physically, ask you about the medications you are on, and inquire about the family medical history. Blood tests are done to check the thyroid hormone level.
Risks for mother
Untreated, or inadequately treated, hypothyroidism has been associated with
- maternal anemia (low red blood cell count)
- myopathy (muscle pain, weakness)
- congestive heart failure
- pre-eclampsia
- placental abnormalities
- low birth weight infants
- Post partum hemorrhage (bleeding)
- These complications are more likely to occur in women with severe hypothyroidism. Most women with mild hypothyroidism may have no symptoms or attribute symptoms they may have as due to the pregnancy.
Fetal Complications
- Premature birth
- Low birth weight
- Neonatal respiratory disorder
- Impaired brain development
DIETARY MANAGEMENT OF HYPOTHYROIDISM:
- A healthy diet for someone with hypothyroidism would include natural foods, whole grains, lots of fruits and vegetables and a good supply of seafood and other lean protein.
- You should cut back on meats that are high in fat.
- A multivitamin is probably a good idea if you don’t already take one
- Strive for whole grains, also known as complex carbohydrates, over refined grains as fiber in whole grains makes you feel full and can help you lose weight, in addition to being helpful for constipation, another side effect of hypothyroidism.
- Alcohol should also be avoided because it can cause blood sugar fluctuations.
- The ideal diet for hypothyroidism will include mini meals spread out through the day rather than three larger meals.
- Your diet should include plenty of water.
- The diet for hypothyroid should not include raw foods such as cabbage, cauliflower, broccoli, Brussels sprouts, mustard greens, kale, spinach, peaches, pears, strawberries, radishes and millet as these fruits, veggies, greens and grains are thought to increase your chances of developing goiter.
- Include exercise if you want to lose weight
- The most effective pranayama is ujjayi. It acts on the throat, and its relaxing and stimulating effects are most probably due to stimulation of ancient reflex pathways within the throat area, which are controlled by the brain stem and hypothalamus. Surya, Chandra, Nadi Sodhana pranayama (right, left and alternate nostril breathing) is useful in re-balancing metabolism.
- Selenium may be the most important nutrient in a diet for hypothyroid as this trace mineral is essential for converting the thyroid hormone T4, into its active form, T3. Brazil nuts are an incredibly good source of selenium, but you can also get it from some lean meats.
Ayurvedic herbs for Thyroid Support
- Punarnava- Lights a fire for slow digestion, especially helpful for toxicity. Punarnava gives a big boost to your metabolic fire. Reduces kapha and aids in weight loss by removing excess water.
- Vacha- Stimulates the mind. Vacha is great for brain fog and kapha type depression.
- Trikatu- Very hot and dry- trikatu jumpstarts the digestive fire. Have a pinch before meals.
- Bacopa- Brightens and sharpens the mind to address brain-fog and depression.
- Eleuthero- Commonly known as Siberian Ginseng. Adaptogenic herb that supports adrenals, which are often compromised in hypothyroid patients.
- Lemongrass- Digestive and boosts fat metabolism.
- Guggulu- Studies show guggulu can increase thyroid output of hormones and stimulate the conversion of the T4 into T3 form, thus addressing two of the three hormonal deficiencies responsible for hyprothyroidism. This can help increase metabolism and burn fat. Gugguisterones (what a fun word!) are the chemical constituent responsible.
- Lemons are especially useful for dry skin in hypothyroid, as it dilates the pores.
- B vitamins- Although not an herb, B vitamins greatly help fatigue
- An easy home formula to improve your circulation: Try an herbal tea with lemon, turmeric, and cinnamon
Note
As we all are genetically different with different constitutions and patterns, we respond to treatments in many different ways. Hence Standard Ayurvedic Treatments are always individually formulated. This article is intended only for information. It is not a substitute to the standard medical diagnosis, personalized Ayurvedic treatment or qualified Ayurvedic physician. For specific treatment, always consult with a qualified Ayurvedic physician.