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TITLE OF CASE

Standalone successful ayurvedic management of Grave's Disease– A Case report

Dr G G Gangadharan

ABSTRACT

A 29-year-old female patient presented with deranged thyroid hormone levels and was diagnosed with hyperthyroidism in November 2018. She took antithyroid medicines for a month. After 1 month, a repeat Thyroid function test showed no improvement, hence she was suggested for Radio iodine therapy, where in the patient was not comfortable starting the therapy. And she consulted a Homeopathy doctor and took medication for 3 months. A thyroid scan done in 2019 revealed hyperplastic goitre of the thyroid gland confirming the biomedical diagnosis as Grave’s disease. She decided to try an alternative treatment and approached Dr G G Gangadharan. The ayurvedic diagnosis was Galaganda. The line of treatment followed was snehapana, abhyanga and virecana to correct the blood circulation and the hormonal imbalance. With the initiation of the standalone ayurvedic treatment, the  deranged thyroid levels were brought to normal limits within a time span of 1 year and 2 months. The patient is continuing the medicines and is in remission.

KEYWORDS

Galaganda, Hyperthyroidism, Graves’ Disease, Ayurveda management, Case report, Standalone

INTRODUCTION

Graves' disease is an autoimmune disease that primarily affects the thyroid gland. It may also affect multiple organs, including the eyes and skin. It is the most common cause of hyperthyroidism.

Graves' disease is caused by thyroid-stimulating immunoglobulin (TSI), a thyroid-stimulating antibody (TSAb). B lymphocytes primarily synthesize Thyroid stimulating immunoglobulin within the thyroid cells, but it can also be synthesized in lymph nodes and bone marrow. B lymphocytes are stimulated by T lymphocytes which get sensitized by antigens in the thyroid gland. Thyroid-stimulating immunoglobulin binds with the thyroid-stimulating hormone (TSH) receptor on the thyroid cell membrane and stimulates the action of the thyroid-stimulating hormone. It stimulates thyroid hormone synthesis and thyroid gland growth, causing hyperthyroidism and thyromegaly.

Pathogenesis of other rare manifestations of Graves disease like pretibial myxedema and thyroid acropachy is poorly understood and is believed to be due to cytokine-mediated stimulation of fibroblasts. Many symptoms of hyperthyroidism like tachycardia, sweating, tremors, lid lag, and stare are thought to be related to increased sensitivity to catecholamine.

Prognosis

This condition is not completely curable. All patients become hypothyroid and require hormone replacement therapy. Similarly, the ocular features of the disorder also become quiescent with time. Some patients may develop a recurrence of hyperthyroidism after ablation, and another therapy with radioactive iodine is needed. While antithyroid drugs do control the symptoms, they do not cure the disease, so relapses are common. The condition is best addressed with radioactive iodine.

  In this case, she was diagnosed as hyperthyroid in November 2018 and started anti-thyroid medication for one month. After a month, a repeat thyroid blood investigation was done, and the result did not show any improvement. She was suggested Radioiodine therapy. As the patient was unwilling to do radioiodine therapy, she opted for Homeo medicine. The biomedical diagnosis was confirmed as Grave’s disease with a thyroid scan. The patient tried homeo medicines for 3 months, but there was no improvement, so she opted for Ayurvedic medicines.

Diagnostic criteria

 In clinicl practice, Blood tests are the most relied upon for confirming the diagnosis. Thyroid blood tests and thyroid antibody tests are the most common. Some other methods adopted in diagnosis are as follows:

1. Measurement of TSH receptor antibody (TRAb)

2. Radioactive iodine uptake scan with I-123 or I-131

3. Thyroid Ultrasonogram with Doppler

4. T3/T4 ratio greater than 20 (ng/mcg) or FT3/FT4 ratio greater than 0.3 (SI unit) suggests Graves disease

PATIENT INFORMATION

A 29-year-old female patient presented with deranged thyroid hormone levels and was diagnosed with hyperthyroidism in November 2018. In 2019, her diagnosis was confirmed as Graves disease based on the findings of a thyroid scan.

Medical History: The patient was asymptomatic, and the deranged thyroid levels were noted during a routine blood test. After 1 month, a repeat Thyroid function test showed no improvement, hence she was suggested for Radio iodine therapy, where in the patient was not comfortable starting the therapy. And she consulted a Homeopathy doctor and took medication for 3 months. A thyroid scan done in 2019 revealed hyperplastic goitre of the thyroid gland confirming the biomedical diagnosis as Grave’s disease. She decided to try an alternative treatment and approached Dr G G Gangadharan for ayurvedic management. 

CLINICAL FINDINGS/PHYSICAL EXAMINATION

Examination of the neck region was done. O/E swelling in the neck region was present.

TIMELINE

Image 1. Timeline of events to be added

DIAGNOSTIC ASSESSMENT

Modern Diagnostic parameter: The biomedical diagnosis was confirmed with blood tests and thyroid scan.

Image 2. Investigations at baseline- Thyroid scan dated 2019 added below

Image 3. Blood parameters during treatment from June to December 2019 were added below

Ayurvedic Assessment was done based on the investigation reports and the clinical evaluation by the ayurvedic physician.

Differential Diagnosis- The diagnosis was confirmed with blood tests and a thyroid scan.  

Prognosis- Grave’s disease is a progressive condition that needs medical care. The condition could be managed only with timely medical care and observation. With the initiation of the standalone ayurvedic treatment, the patient  the deranged thyroid levels became  normal within a period of 1 year and 2 months.

THERAPEUTIC INTERVENTION

See the tab ‘Treatment details’

FOLLOW-UP AND OUTCOMES

Clinician-based assessment; Routine laboratory investigations were within normal limits. T3, T4 and TSH levels are brought to normal limits with treatment and lifestyle modification. Follow up period was uneventful, and the patient achieved complete remission

Patient-assessed:  Not relevant.    

Table 1. The thyroid values recorded pre and post-ayurvedic treatment are added below

Image 4. Thyroid value after treatment added below

Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well.

Method of assessment- By monitoring the patient and the thyroid levels.

Adverse and unanticipated events; None reported.

DISCUSSION ;

Snehapana followed by abhyanga, bashpa sweda and virechana improved blood circulation and hormonal correction to a certain extent. Gayatryadi and  Trayantyadi kashaya targeted improved immunity and dhatu satmya. Simhanada guggulu, Tonsari cap, Varunadi ghritam and thryroflux targeted  preventing  the enlargement of the gland.

PATIENT’S PERSPECTIVE

Not available.

LEARNING POINTS/TAKE-HOME MESSAGES

This case report highlights the efficacy of standalone ayurvedic management of Grave’s disease which was suggested for Radio iodine therapy. The patient is now able to lead a normal life as she continues with the ayurvedic treatment. Regular follow-up was continued for a time period of 1 year and 10 months. The blood levels were stable  to date. 

INFORMED CONSENT

Written consent was obtained from the patient to publish the case report.

CONFLICT OF INTEREST

None declared.

FUNDING

None

REFERENCE

1. Smith TJ, Hegedüs L. Graves' Disease. N Engl J Med. 2016 Oct 20;375(16):1552-1565. doi: 10.1056/NEJMra1510030. PMID: 27797318.
2. Susruta Samhita. Nidana sthana. 11

Image 1. Timeline

Image 2. Investigations at baseline Thyroid scan dated 2019

Image 3. Blood parameters during treatment from June to December 2019

Table 1. The thyroid values recorded pre and post-ayurvedic treatment are added below

 

	TSH	T3	T4
Before treatment	0.008mcIU/ml	2.98 ng/dl	16.2ug/dl
After treatment	0.74mcIU/ml	1.07 ng/dl	8.40ug/dl

 

Image 4. Thyroid value after treatment