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Introduction

Hypothyroidism is a commonly encountered endocrine disorder characterized by reduced thyroid(T3,T4) hormone activity, resulting in a generalized slowing of metabolic processes and diverse systemic manifestations. From a modern clinical perspective, the condition presents with symptoms such as lethargy, weight gain, cold intolerance, bowel irregularities, menstrual disturbances, and neuropsychological changes. Its prevalence varies globally, affecting 2-5% of the general population. The current standard of care relies predominantly on long-term or lifelong thyroid hormone replacement therapy. Although this approach effectively improves biochemical parameters and alleviates overt symptoms, it primarily offers symptomatic control. Persistent metabolic sluggishness, incomplete resolution of clinical features in some individuals, and the inability to address the underlying functional and metabolic imbalance highlight the limitations of exclusive hormone-based management. Ayurveda provides a distinct and holistic framework for understanding such metabolic disorders through the principles of Agni, Dosha, Dhatu, and Strotas.(4) While hypothyroidism is not described as a separate disease entity in classical Ayurvedic texts, its clinical presentation can be interpreted as a manifestation of Agnimandya predominantly associated Kapha and Vata vitiation leading to dysfunction of Rasa and Meda Dhatu. Therefore, to elucidating the Ayurvedic pathogenesis (Samprapti) and outlining appropriate management principles is essential for developing a comprehensive and root-oriented approach to hypothyroidism.

Material and Methods-

A narrative analytical review of classical Ayurvedic texts i.e.Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya was undertaken, alongside appraisal of contemporary scientific literature on Pubmed, Google Scholar and other web searches related to hypothyroidism, metabolism, and integrative medicine. Ayurvedic concepts were systematically mapped to modern physiological and pathological correlates.

Discussion

There are two primary thyroid hormones T3 and T4 that influence every system in the body, either directly or indirectly, throughout all stages of life. These hormones are essential for growth as they enhance the absorption of amino acids by tissues and support the enzymatic processes involved in protein synthesis, which in turn promotes bone development. These hormones are essential for growth as they enhance the absorption of amino acids by tissues and support the enzymatic processes involved in protein synthesis, which in turn promotes bone development. Thyroid hormones also regulate carbohydrate metabolism by stimulating the uptake of glucose, breaking down glycogen into glucose, and producing glucose from non-carbohydrate sources. Thyroid hormones also regulate carbohydrate metabolism by stimulating the uptake of glucose, breaking down glycogen into glucose, and producing glucose from non-carbohydrate sources. These functions are similar to the role of Rasavaha Strotasa, which nourishes and energizes all body tissues. They also aid in fat metabolism by releasing lipids from fat stores and accelerating their breakdown to generate energy, a process akin to the function of Medovaha Strotas. They also aid in fat metabolism by releasing lipids from fat stores and accelerating their breakdown to generate energy, a process akin to the function of Medovaha Strotas. Thyroid hormones elevate the basal metabolic rate (BMR) in most tissues except the brain, spleen, and gonads. This leads to increased heat production and higher oxygen usage. The heightened metabolic rate also boosts the use of energy sources, which can result in weight loss. These effects are comparable to the functions of Agni in the body [4]. The action of thyroid hormones also increases adrenergic receptors in blood vessels, helping to regulate blood pressure. Thyroid hormones are crucial for tissue growth, especially in the skeletal, nervous, and reproductive systems. In terms of cardiovascular effects, they increase cardiac output, heart rate, and the strength of heart muscle contractions. They influence the respiratory system indirectly by raising BMR, which increases the body's demand for oxygen and the excretion of carbon dioxide. When viewed from an Ayurvedic perspective, these physiological actions correspond to the normal functions of Pitta and Vata Dosha. The main Srotases affected by thyroid hormones are Rasavaho Srotas, Mamsavaha, Medovaha Srotas, Asthivaha Srotas, and Sukravaha Srotas.

Ayurvedic Etiopathogenesis of Hypothyroidism-

Ama-jir?a- Ama-Jirna arises from persistent Agnim?ndya, leading to incomplete digestion and formation of Ama. In hypothyroidism, reduced metabolic activity mirrors Jathar?gni and Dhatv?gni Mandya, favoring chronic ?ma accumulation. Ama-associated Kapha and V?ta cause Srotorodha of Annavaha and Rasavaha Srotas. This results in Gaurava, Alasya, Aruchi, Vibandha, and Daurbalya commonly seen in hypothyroid patients. Chronic Ama further vitiates Meda Dh?tu, contributing to ?hotha and metabolic impairment. Hence, hypothyroidism can be understood as an Agnim?ndya-janya disorder with significant Ama involvement.

Santarpanottha Vikara- Santarpanottha Vik?ra arises from excessive nourishment and sedentary habits, leading to Kapha and Meda prakopa with Agnim?ndya. In hypothyroidism, reduced metabolic activity closely resembles this Santarpana-induced pathological state. Meda Dh?tu vriddhi causes Srotorodha of Rasavaha, Medovaha, and Udakavaha Srotas. Obstructed V?ta gati further aggravates metabolic and circulatory

impairment. Clinically, features such as Sthoulya, Gaurava, Alasya, ?otha, and ?aitya are commonly observed. Hence, hypothyroidism can be conceptualized as a Santarpanottha, Kapha-Meda pradh?na disorder.

Shotha – Shotha in hypothyroidism represents a classical example of Kapha-pradh?na Rasavaha–Udakavaha Srotodushti with Kaph?v?ta V?ta, resulting in myxedematous tissue infiltration. The underlying Agnim?ndya at both Jathar?gni and Dhatv?gni levels leads to improper formation and circulation of Rasa Dh?tu, promoting fluid retention and interstitial accumulation. Progressive Meda Dh?tu vriddhi and Ama association further aggravate Srotorodha, impairing normal V?ta gati and metabolic regulation. This pathological cascade manifests clinically as painless, non-pitting edema associated with Gaurava, ?aitya, and Mandat?, which closely parallels the classical description of Kaphaja ?otha. Understanding this pathogenesis (Sampr?pti) provides a rational basis for adopting Kapha-V?ta hara, Agni d?pana, Srotoshodhana-oriented chikits? in the integrative management of hypothyroidism.

Meda-Aav?ta Vata – Meda-?v?ta V?ta denotes obstruction of V?ta gati by vitiated Meda Dh?tu due to persistent Agnim?ndya. In hypothyroidism, Meda vriddhi causes Srotorodha of Rasavaha, Medovaha, and Udakavaha Srotas, impairing metabolism and circulation. Obstructed Vy?na and Ud?na V?ta lead to Gaurava, Alasya, ?otha, and ?aitya. Kapha dominance further contributes to fluid retention and tissue infiltration. This pathological state closely resembles myxedematous edema of hypothyroidism. Thus, hypothyroidism may be understood as a Kapha–Meda pradh?na condition with secondary Meda-?v?ta V?ta.

Galga??a – Galga??a is a Kapha-pradh?na disorder characterized by localized swelling in the griva Pradesh. In hypothyroidism, thyroid enlargement and hypofunction closely resemble the classical features of Galga??a. Agnim?ndya leads to Kapha–Meda accumulation and Srotorodha in the neck region. Obstruction of Udana and Vyana Vata results in impaired glandular function. Clinical features such as Galasopha, Gaurava, ?aitya, and Mandata show strong similarity. Hence, hypothyroidism can be understood as a Galga??a-svar?pa, Kapha-dominant disorder.

Uptapta Mana- Uptapta Mana represents a disturbed mental state caused by vitiation of Manasika Do?has with involvement of Pra?a Vata and Sadhaka Pitta. In hypothyroidism, chronic Agnimandya and Kapha dominance adversely affect Manovaha Srotas. Obstruction of Pra?a and Udana Vata leads to mental dullness and reduced cognitive function. Clinically, Sm?ti-mandata, Alasya, Utsaha-hani, and Vi?ada are commonly observed. These features closely resemble the classical description of Uptapta Mana. Hence, hypothyroidism should be viewed as a psychosomatic disorder requiring holistic management.

Samprapti of Hypothyroidism-

Nidana

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Kapha-Vardhaka Ahara–Vihara

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Jatharagni Mandya

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Ama Utpatti

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Ama circulation through Rasavaha Srotas

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Rasa Dhatu Dushti

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Impaired nourishment of Dhatus

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Medovaha Srotas Dushti + Meda Dhatu Vriddhi

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Dhatvagni Mandya (Rasa & Meda level)

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Srotorodha

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Kapha Dosha Prakopa

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Secondary Vata Dosha Anubandha

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Signs and symptoms like Galasopha, Gaurava, ?haitya, and Mandat?

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                             Clinical Manifestations resembling Hypothyroidism

i.e.Weight gain, cold intolerance, fatigue, constipation, cognitive slowing)

Samprapti Ghataka’s-

• Dosha - Vata-Kapha
• Dushya - Rasa, Rakta, Mamsa, Meda, Asthi, Shukra
• Agni - Jatharagnimandya, Dhatwagnimandya
• Srotodushti - Sanga, Vimargagamana
• Rogamarga - Bahya, Abhyantara,Madhyama(7)

In Ayurvedic literature, hypothyroidism is not described as an independent disease entity; however, its clinical presentation can be interpreted through fundamental concepts of Dosha, Agni, Dhatu, and Strotas.The pathophysiology primarily originates from Agnimandya, characterized by a reduction in digestive and tissue metabolic capacity, leading to systemic metabolic dysfunction. Chronic exposure to Kapha-aggravating dietary factors—including excessive intake of Guru (heavy), Snigdha (unctuous), Madhura (sweet), and Sheeta (cold) foods—along with sedentary behavior and psychological stress, results in impairment of Jatharagni. Ama, when circulated through the Rasavaha Strotas, disrupts the qualitative integrity of Rasa Dhatu, leading to inadequate tissue nourishment. Progressive involvement of Medovaha Strotas results in Meda Dhatu vriddhi and Dhatvagni Mandya at the tissue level, impairing lipid metabolism and energy utilization. Accumulation of Ama and Meda causes Strotorodha.

 Signs and Symptoms-

Table No.1) Clinical presentations of Hypothyroidism w.r.s. to Dosha and Srotas involvement

PRINCIPLE OF MANAGEMENT-

The line of treatment with specific target to Agni, Rasavaha, Mamsavaha, Medovaha, Manovaha Srotas as well as Vata and Kapha Dosha should be administered in Hypothyroidism.

1. Various mode of action of Ayurvedic Kalpas’s in Aamajirna-

Lashunadi Vati, Panchkola, Amruttottar Kashaya, and Pippalyasava act synergistically in hypothyroidism by correcting Agnimandya and facilitating ?ma P?chana, thereby improving metabolic and digestive functions. These formulations predominantly possess u?h?a, t?k??a, laghu, and ruk?ha gu?a with katu rasa and u?h?a v?rya, making them effective in pacifying Kapha–V?ta do?a. Panchkola and Pippalyasava strongly stimulate Jatharagni and Dhatvagni, reducing sluggish metabolism and weight gain. Lashunadi Vati and Amruttottar Kashaya support proper tissue metabolism and endocrine balance. Collectively, they help alleviate symptoms such as lethargy, heaviness, fatigue, and impaired metabolic activity associated with hypothyroidism.

1.  Action on Santrpanototh Vikar-

 Aarogyavardhini Vati enhances Jatharagni and Dhatvagni, corrects Ama du??i, and supports Medo Dhatu metabolism, thereby improving sluggish metabolism and weight imbalance seen in hypothyroidism. Chandraprabha Vati regulates Kapha–Vata dho?a, supports mutravaha and medovaha srotas, and improves systemic metabolic and hormonal balance. Tapyadi Loha strengthens Rasa–Rakta Dhatu formation, corrects Dhatvagni m?ndya, and helps manage anemia, fatigue, and weakness commonly associated with hypothyroidism. Shiva Gutika acts as a potent Ras?yana, improving Agni, vitality, and tissue nourishment. Collectively, these formulations restore metabolic efficiency, enhance hormonal homeostasis, and improve overall strength and immunity in hypothyroid states.

1.  Action on Shoth-

In ?hotha associated with hypothyroidism, these formulations act by correcting Agnimandya and improving Rasa–Rakta dh?tu metabolism. They reduce Kapha accumulation, relieve edema, and alleviate heaviness and sluggishness.

 Punarnava-based preparations promote diuresis and support yak?ut–pl?h? (liver–spleen) functions, aiding fluid balance. Dashm?l?ri??a pacifies V?ta–Kapha do?a and restores metabolic equilibrium. M????ra Bhasma and ?a?adh?ra?a Ch?r?a enhance dh?tu nourishment and Agni, collectively reducing swelling and improving systemic metabolism.

1.  Action on Meda -aavrutta Vata-

In Meda-?v?tta V?ta associated with hypothyroidism, formulations such as Gom?tra Har?tak?, Nav?yasa Loha, Varu??di Ka??ya, Chitrak?di Gu?ik?, Loha Bhasma, Triphal?, and Trika?u act by correcting Agnimandya and promoting effective ?ma p?chana. These drugs reduce Kapha–Meda du??i, clear srotorodha, and enhance metabolic and glandular functions. Nav?yasa Loha and Loha Bhasma improve Rasa–Rakta dh?tu formation and correct Dhatvagni mandya. Triphal? and Trika?u provide d?pana, p?chana, v?ta anulomana, and srotoshodhana, aiding digestion and lipid metabolism. Collectively, they help manage weight gain, hyperlipidemia, sluggish metabolism, and v?ta obstruction seen in hypothyroidism.

1.  Action on Galgand –

In Galganda associated with hypothyroidism, formulations such as Kanchanara Guggulu, Kukut?nakki Guggulu, Laghumalini Vasant, and Hansapadadi Kwatha play a significant therapeutic role. Kanchanara Guggulu regulates thyroid gland function, reduces glandular swelling, and acts through Agni d?pana, ?ma p?chana, and Raktapras?dana. Kukut?nakki Guggulu corrects Kapha–Medo du??i, improves Agni, and supports glandular and metabolic balance. Laghumalini Vasant enhances Agni and Dhatvagni, acts as a Rasayana, and alleviates fatigue, weakness, and dh?tu k?aya. Hansapadadi Kwatha further supports Kapha alleviation and helps in reducing goitre-related swelling and metabolic sluggishness.

1. Action on Upatapta Manas-

 In Upatapta Manas associated with hypothyroidism, formulations such as Mansmitra Vataka, Suvarna Malini Vasant, and medhya dravyas play a vital supportive role. Mansmitra Vataka enhances Agni and Medo Dhatu metabolism, thereby reducing fatigue, lethargy, and body heaviness while improving strength and energy levels. Suvarna Malini Vasant acts as a Rasayana, supporting Rasa–Rakta Dhatu and endocrine functions, and alleviating weakness and metabolic sluggishness. Brahmi, Vacha, and Tagara enhance medhya and neuroendocrine functions, promoting mental clarity and hormonal balance. Collectively, these interventions help relieve stress, mental fatigue, and sluggishness commonly seen in hypothyroid patients.

Conclusion

Chronic exposure to Kapha-aggravating dietary factors—including excessive intake of Guru (heavy), Snigdha (unctuous), Madhura (sweet), and Sheeta (cold) foods—along with sedentary behaviour and psychological stress, results in impairment of Jatharagni.  Ama is a metabolically hazardous byproduct that is created as a result of Jatharagni mandya (ineffective digestion). Inadequate tissue nourishment results from Ama disruption of Rasa Dhatu's qualitative integrity when it passes through the Rasavaha Strotas. Agnimandya is the main cause of the pathophysiology, which is typified by a decrease in tissue and digestive metabolic capacity that results in systemic metabolic dysfunction. Hypothyroidism, though not described as an independent disease entity in classical Ayurvedic literature, can be clearly interpreted through the principles of- Agnimandya, Kapha–Vata imbalance, and dysfunction of Rasa and Meda Dhatu. The clinical features of the condition reflect impaired metabolic activity and obstruction of physiological channels, providing a coherent Ayurvedic explanation for its systemic manifestations. Understanding the pathogenesis (Samprapti) of hypothyroidism forms the foundation for its Ayurvedic management. Therapeutic emphasis is placed on interruption of pathogenesis, through restoration of metabolic fire, pacification of aggravated Dosha Kapha and Vata), Dhatus (Ras, Rakta, Mansa, Meda etc.) and normalization of tissue and srotas(channels) function. Thus, an Ayurve dic approach offers a rational, root-oriented framework for the management of hypothyroidism, highlighting its relevance in addressing the underlying metabolic disturbance rather than focusing solely on symptomatic control.