ArticlePDF Available

Effect of yoga on subclinical hypothyroidism: a case report.

Authors:
  • Sri Balaji Vidyapeeth (Deemed University)

Abstract

Introduction: Complementary and Alternative Medical (CAM) therapies such as yoga are being increasingly used as adjuncts to modern medicine. Though it has been suggested that yoga may have a role in revitalizing thyroid function there are few studies on the effects of yoga on thyroid disorders. Case history: A 36 year old female with elevated TSH level (9.39 IU/ml) and low normal T4 levels (12.57 pmol/L) was diagnosed as having primary subclinical hypothyroidism and advised to start replacement therapy. She came for consultation to the ACYTER Yoga OPD at JIPMER, Pondicherry and was given appropriate yogic counseling and taught a series of techniques potentially beneficial to patients of thyroid conditions. She continued the practices for a year and reported back at the end of the year with her biochemical investigations. Results: After one year of therapy, there was a fall in TSH (2.66 mIU/L) and a normalization of free T4 values (8.98 pmol/L). A third biochemical analysis three months later showed that TSH further stabilized 2 mIU/L and FT4 at 9.78 pmol/L. As the anti TPO antibodies were positive both before and after the yoga intervention, the patient was advised to continue the yoga practices on a regular basis as long as possible with regular six-monthly follow up. Conclusion: it is suggested that yoga can be an effective adjunct therapy in thyroid conditions and further studies in larger samples are needed to confirm these findings and to better understand the mechanisms behind such beneficial effects in patients of thyroid disorders.
i
iÉnäùEòÉä%´Éʶɹ]õ: ʶɴÉ: Eäò´É±ÉÉä%½þ¨É *
I alone persist : Blissful : Absolute.
ºÉ´ÉÈ JÉα´ÉnÆù ¥ÉÀ *
All this is, indeed, Brahman
xÉä½þ xÉÉxÉÉκiÉ ÊEò\SÉxÉ *
There is nothing here apart from it
¶É®úÒ®ú¨ÉÉtÆ JɱÉÖ vɨÉǺÉÉvÉxɨÉ *
Surely Health is the primary requisite of spiritual life.
July 2011
Vol. XLIII No. 2
KAIVALYADHAMA
SWAMI KUVALAYANANDA MARG,
LONAVLA - 410 403 (Maharashtra), INDIA
• E-mail: kdham@vsnl.com • Tel. : 091-2114-273001
• Fax : 091-2114-271983 Website: www.kdham.com
ºÉÉä%½þ¨É *
YOGA-MÌMËêSË
(Recommended by the Govt. of India, Ministry
of Education for the Libraries of Universities
and Physical Education Training Institutions
Vide Letter No : F.9-4/68,YS-4 dated 15.7.1968,
Regd.No. R.N.11402-58, ISSN:0044-0507)
Yoga M¢m¡Æs¡, Vol. XLIII No. 2 : 102-107 July, 2011
EFFECT OF YOGA ON SUBCLINICAL HYPOTHYROIDISM :
A CASE REPORT
BHAVANANI, ANANDA BALAYOGI1; ZEENA SANJAY2 AND MADANMOHAN3
ABSTRACT
Complementary and Alternative Medical (CAM) therapies such as yoga are being increasingly
used as adjuncts to modern medicine. Though it has been suggested that yoga may have a role in
revitalizing thyroid function there are few studies on the effects of yoga on thyroid disorders.
Case history: A 36 year old female with elevated TSH level (9.39 IU/ml) and low normal T4
levels (12.57 pmol/L) was diagnosed as having primary sub-clinical hypothyroidism and advised
to start replacement therapy. She came for consultation to the ACYTER Yoga OPD at JIPMER,
Pondicherry and was given appropriate yogic counseling and taught a series of techniques
potentially beneficial to patients of thyroid conditions. She continued the practices for a year and
reported back at the end of the year with her biochemical investigations. Results: After one year
of therapy, there was a fall in TSH (2.66 mIU/L) and a normalization of free T4 values (8.98
pmol/L). A third biochemical analysis three months later showed that TSH further stabilized 2
mIU/L and FT4 at 9.78 pmol/L. As the anti TPO antibodies were positive both before and after
the yoga intervention, the patient was advised to continue the yoga practices on a regular basis as
long as possible with regular six-monthly follow up. Conclusion: it is suggested that yoga can be
an effective adjunct therapy in thyroid conditions and further studies in larger samples are needed
to confirm these findings and to better understand the mechanisms behind such beneficial effects
in patients of thyroid disorders.
Key words: Subclinical hypothyroidism, yoga therapy, psycho-neuro-endocrinology
Introduction
In recent times there is a shift in paradigm and Complementary and Alternative Medical
(CAM) therapies such as yoga are being increasingly used as adjuncts to modern medicine. It
has been suggested that yoga may have a role in revitalizing thyroid function as well as improving
psycho-neuro-endocrine function on the whole (James Funderburk 1977, Singh RH 1982). Though
1. Programme Co-ordinator, ACYTER, JIPMER, Puducherry, India. Email: ananda@icyer.com
2. Senior Research Fellow, ACYTER, JIPMER, Puducherry, India.
3. Professor and Head, Physiology and Programme Director , ACYTER, JIPMER, Puducherry, India.
YM, Vol. XLIII No. 2 102 Bhavanani, et al. (2011)
numerous studies have shown the psycho-physiological benefits and therapeutic potential of
Yoga (Khalsa 2004) there are few studies on the effects of yoga on thyroid disorders.
Hypothyroidism refers to a condition where the thyroid gland is not producing sufficient
amounts of hormones. As there are intricate feedback mechanisms between the thyroid and
anterior pituitary, hypothyroidism is classified as primary when thyroxin (T4) and triiodothyronine
(T3) levels are low but levels of thyroid stimulating hormone (TSH) secreted by anterior pituitary
high. It is classified as secondary when TSH is low and T4 and T3 levels are high.
Sub-clinical hypothyroidism is a condition where TSH levels are elevated but T4 and T3
levels are usually found to be in the normal laboratory reference ranges. Prevalence in the US
adult population ranges from 4 to 8.5% with an increase with age. It is also more common in
women. Sub-clinical hypothyroidism may manifest without any major thyroid related symptoms
as cellular metabolic rates may not be affected in many cases. Approximately 2 to 5 % of these
patients will progress to overt hypothyroidism per year (Martin I Surks 2004). Opinion is divided
on the biochemical and symptomatic point at which to start replacement therapy with
levothyroxine that is the usual management of clinical hypothyroidism. One needs to be cautious
as there is always the risk of iatrogenic hyperthyroidism.
Case Report
History
A 36 year old female, working in Kuwait presented to her clinician with the complaints of
hair fall and a feeling of general lethargy. There were no other major thyroid related symptoms
through she was anxious about her condition. As her blood tests revealed an elevated TSH level
and low normal T4 levels she was diagnosed as having primary hypothyroidism and advised to
start replacement therapy with levothyroxine as she tested positive for anti TPO antibodies. The
patient put off starting the medication as she was visiting Pondicherry to visit her father for a
short holiday with family. As she wished to avoid lifelong replacement therapy, on the suggestion
of her father who is a YOGA enthusiast she came for consultation to the ACYTER Yoga OPD
that is functioning since June 2009 at JIPMER, Pondicherry. She had no apparent thyroid
enlargement and her vitals were within normal limits. However she was anxious about her
condition and the necessity of taking levothyroxine life long. She was given appropriate yogic
counseling and dietary advice and taught a series of techniques that are potentially beneficial to
patients of thyroid conditions. She continued the practices for one year and reported back at the
end of the year with her biochemical investigations. Her biochemical results showed a fall in
YM, Vol. XLIII No. 2 103 Bhavanani, et al. (2011)
EFFECT OF YOGA ON SUBCLINICAL HYPOTHYROIDISM : A CASE REPORT
YM, Vol. XLIII No. 2 104 Bhavanani, et al. (2011)
EFFECT OF YOGA ON SUBCLINICAL HYPOTHYROIDISM : A CASE REPORT
TSH and a normalization of free T4 values. She also reported less hair fall and a sense of well
being. In fact she commented that many of her colleagues at work had noticed the positive
changes in her attitude and day to day activities and were interested in what she has doing so that
they could benefit themselves. As the anti TPO antibodies were positive both before and after
the yoga intervention, the patient has been advised to continue the yoga practices on a regular
basis as long as possible with regular six-monthly follow up.
Investigations
The initial biochemical investigations detected that her TSH was 9.39 IU/ml (normal range
for the laboratory is given as 0.27 to 4.20 mIU/L) and FT4 value was 12.57 pmol/L which is at
the lower normal level of the range for that laboratory (12 to 22 pmol/L). Following 6 months of
Yoga therapy, TSH fell to 2.66 mIU/L (normal range for the laboratory is given as 0.37 to 4
mIU/L) while FT4 was 8.98 pmol/L which is mid normal of the range for that laboratory (7.5 to
21 pmol/L). A third biochemical analysis three months later showed that TSH was 2 (normal
range for the laboratory 0.27 to 4.20 mIU/L) and FT4 was 9.78 (normal range for the laboratory
7.86 to 14.4 pmol/L). Anti TPO antibodies were positive both before and after the yoga
intervention.
Yoga therapy
The patient was given appropriate yogic counseling and dietary advice and taught the following
techniques that may be potentially beneficial to patients of thyroid conditions. The techniques
included s£rya namask¡ra, j¡landharabandha, vipar¢takara¸i and brahmamudr¡ in addition to
¡sanas such as triko¸a, vakra, ardha matsyendra, pawanamukta and sarva´g¡sana. She also
received training in s£ryan¡·i, pra¸ava, ujj¡yi and bhr¡mari pr¡¸¡yama and relaxation techniques
done in ¿av¡sana.
Discussion
The consensus report generated by the Consensus Development Conference (2002)
cosponsored by the American Association of Clinical Endocrinologists (AACE), the American
Thyroid Association (ATA), and The Endocrine Society (TES), has suggested that the upper
limit of TSH should be considered as 4.5 mIU/L. It also states that since available data do not
convincingly show clear-cut benefit from early thyroxine therapy, routine T4 treatment for patients
with TSH between 4.5 and 10 mIU/L is not warranted. Martin I Surks et al (2004) concluded that
data supporting associations of sub-clinical thyroid disease with symptoms or adverse clinical
YM, Vol. XLIII No. 2 105 Bhavanani, et al. (2011)
EFFECT OF YOGA ON SUBCLINICAL HYPOTHYROIDISM : A CASE REPORT
outcomes or benefits of treatment are few. They have recommended against routine treatment
of patients with TSH levels ranging from 4.5-10 mIU/L. as the consequences of sub-
clinical thyroid disease are minimal.
However the AACE Clinical Practice Guidelines for the Evaluation and Treatment of
Hyperthyroidism and Hypothyroidism (2002 Update) suggests that thyroid antibodies should be
measured in patients having sub-clinical hypothyroidism and used as a clinical tool in deciding
upon treatment. AACE guidelines also recommend treatment of patients with TSH > 5mIU/L if
the patient has a goiter or if thyroid antibodies are present.
Two randomized controlled trials in patients with TSH values less than 10mIU/L found no
symptomatic improvement following treatment with thyroxine (Meier C 2001 and Kong WM
2002). However caution is advised as there is a risk of progression to overt hypothyroidism. A
20 year follow up study showed a correlation of this with TSH levels and anti TPO antibodies
(Bijay 2008).
Yoga has great potential as an adjunct therapy as it is cost effective and may not have any
complications when practiced in a proper manner and under expert guidance. Many patients are
nowadays also opting to try out yoga either before starting medications, or in combination with
medication. The position statement of the AACE on Sub-clinical Thyroid Disease clearly states
that until adequate data are available, best practice combines clinical judgment with patient
preferences. In this case, the patient's preference was to use yoga as a method to prevent her sub-
clinical hypothyroidism from developing into full blown hypothyroidism and to avoid taking the
replacement therapy as long as possible.
Yoga therapy imparted to this patient included techniques that may stimulate the thyroid
such as viparitakara¸i, sarva´g¡sana and j¡landhara bandha. One of the pioneers of reach in
Yoga, K. N. Udupa (1985) of the BHU, Varanasi reported that head-low posture reduced levels
of circulating catecholamine, improved tolerance to stress hence may act as a tranquilizer. These
practices may help normalize thyroid function and also improve neuro-endocrine feedback
mechanisms. This may also be accentuated by the pr¡¸¡y¡ma practices like bhr¡mari and pra¸ava
that may bring about such benefit through central action on either the hypothalamus or the limbic
cortex.
Forfar et al (1982) reported a reduction in left ventricular ejection fraction and myocardial
contractile performance in hypothyroid patients. A study of systolic time intervals in hypothyroid
patients by William F. Crowley et al (1977) reported that pretreatment systolic time intervals
YM, Vol. XLIII No. 2 106 Bhavanani, et al. (2011)
EFFECT OF YOGA ON SUBCLINICAL HYPOTHYROIDISM : A CASE REPORT
were characterized by prolongation of the pre-ejection period and reduction of left ventricular
ejection period. A previous study from our laboratory has demonstrated that three months of
pr¡¸¡y¡ma training modulates ventricular performance by increasing parasympathetic activity
and decreasing sympathetic activity (Udupa 2003).
The practice of yoga is known to educe a sense of subjective well (Malathi) and a study done
at the Integral Health Clinic of AIIMS, New Delhi reported that state and trait anxiety scores
were significantly reduced following a comprehensive but brief lifestyle intervention based on
yoga. Subjects in that study included patients of thyroid disorders (Gupta N 2006). Yogic
relaxation techniques may be producing psycho-somatic harmonization and inducing a sense of
calm due to hypo-metabolic activity as has been described in meditation by RK Wallace (1971).
A reduction in metabolic activity could be indirectly reducing the bodily demand for thyroxin as
demonstrated by S. B. Rawal and colleagues (1994).
Further studies in larger samples are needed to confirm these findings and to better understand
the mechanisms behind such beneficial effects of yoga in patients of thyroid disorders.
References
Vaidya, Bijay; Pearce, Simon H S (2008) Management of hypothyroidism in adults: Clinical
review. BMJ 337:a801
Funderburk, James. (1977) Science Studies Yoga: A Review of Physiological Data. Honesdale,
Penn.: Himalayan International Institute of Yoga Science & Philosophy.
Gupta N.; Khera S,; Vempati R.P, Sharma R.; Bijlani, R.L. (2006) Effect of yoga based lifestyle
intervention on state and trait anxiety. Indian J Physiol Pharmacol., 50(1):41-7.
Hossein Gharib, Rhoda H Cobin, H Jack Baskin. (2010). Position statement of the AACE on
Subclinical Thyroid Disease. www.aace.com / pub / positionstatements / subclinical.php.
Forfar , J.C.; Muir, A.L.; Toft, A.D. (1982). Left ventricular function in hypothyroidism:
Responses to exercise and beta adrenoceptor blockade. Br Heart J. 48: 278-84
Khalsa, S.B.S. (2004) Yoga as a therapeutic intervention: a bibliometric analysis of published
research studies. Indian J Physiol Pharmacol; 48 (3): 269-285.
Kong, W.M.; Sheikh, M.H.; Lumb, P.J. et al. (2002) A 6-month randomized trial of thyroxine
treatment in women with mild subclinical hypothyroidism. Am J Med;112:348-354
YM, Vol. XLIII No. 2 107 Bhavanani, et al. (2011)
EFFECT OF YOGA ON SUBCLINICAL HYPOTHYROIDISM : A CASE REPORT
Malathi, A.; Asha, D.; Shah, N. et al. ( 2000) Effect of yoga practices on subjective well being.
Indian J Physiol Pharmacol; 44 (2) : 202-206.
Martin, I.; Surks, Eduardo Ortiz, Gilbert H Daniels et al. (2004) Subclinical Thyroid Disease:
Scientific Review and Guidelines for Diagnosis and Management. JAMA. 291: 228-238.
Meier, C.; Staub, J.J.; Roth, C.B. et al. (2001) TSH-controlled L-thyroxine therapy reduces
cholesterol levels and clinical symptoms in subclinical hypothyroidism: a double-blind,
placebo-controlled trial. J Clin Endo Metab;86:4860-4866
Rawal, S.B.; Singh, M.V.; Tyagi, A.K.; Selvamurthy, W.; Chaudhuri, B.N. (1994) Effect of
yogic exercises on thyroid function in subjects resident at sea level upon exposure to high
altitude. Int J Biometeorol.; 38(1):44-7.
Singh, R.H..; Shettiwar, R. M.; Udupa, K.N. (1982) Physiological and therapeutic studies on
yoga. The Yoga Review, 2(4):185-209.
Udupa K, Madanmohan, Bhavanani AB, Vijayalakshmi P, Krishnamurthy N. (2003) Effect of
pranayam training on cardiac function in normal young volunteers. Indian J Physiol
Pharmacol; 47(1):27-33.
Udupa K.N, (1985). Stress and Its Management by Yoga, Motilal Banarsidass, Delhi - pp. 146-
161
Wallace R. K,; Benson H,; Wilson A.F. (1971) A wakeful hypometabolic physiologic state. Am
J Physiol;221 (3):795-9.
William F Crowley, E Chester Ridgway, Edward W Bough, Gary S Francis, Gilbert H Daniels,
Ione A Kourides, Gordon S Myers, Farahe Maloof. (1977). Noninvasive Evaluation of
Cardiac Function in Hypothyroidism -Response to Gradual Thyroxine Replacement. N Engl
J Med; 296:1-6
Authors' Note
The authors thank Mrs. Lalitha Shanmugam for imparting the Yoga Therapy at the Yoganjali
Natyalayam city centre of ICYER, Pondicherry. We also thank the Director, MDNIY and Director,
JIPMER for their support as this study was possible only because ACYTER has been established
as a collaborative venture between the Morarji Desai National Institute of Yoga, New Delhi and
JIPMER, Puducherry with funding from Department of AYUSH in the Ministry of Health and
Family Welfare, Government of India.
... Thyroid is one among the most common diseases prevalent in the recent years and is more commonly seen in women. With early diagnosis and treatment, one can manage symptoms like weight gain, fatigue, increased sensitivity to cold, constipation etc., and prevent complications like heart problems, mental health issues, infertility, birth defects etc., [4,5,13]. Yoga which started as a complementary therapy is slowly progressing towards considering it as an alternative therapy for many health conditions like low back pain, asthma, diabetes mellitus, high blood pressure etc. ...
... In this direction, it becomes essential and important to focus on customising or developing a validated yoga module for specific health conditions. To study the effect of yoga on thyroid dysfunction, very few studies are available [1,5,6,13,14,15]. In a study of 20 subjects having thyroid condition, yoga was found effective in addressing problems such as weight gain, tiredness, hair loss, constipation, weight loss, tremor, laziness and improper hormone level [13]. ...
... To study the effect of yoga on thyroid dysfunction, very few studies are available [1,5,6,13,14,15]. In a study of 20 subjects having thyroid condition, yoga was found effective in addressing problems such as weight gain, tiredness, hair loss, constipation, weight loss, tremor, laziness and improper hormone level [13]. The yogic practices brought changes in the thyroid disordered patients. ...
Article
Introduction: Prevalence of hypothyroidism is found high in India in the recent years and is more commonly seen in women. While treating the condition with pharmacological intervention, importance of exercise, diet and lifestyle modifications play a significant role in managing the condition. Yoga based techniques have shown positive impact in managing hypothyroid related symptoms. Yoga when considered as a therapeutically approach needs to be customised by considering specific yogic techniques for the targeted health condition and it is also essential to validate the yoga module for a given health condition. While there are a few validated yoga modules for managing obesity, backpain etc., there are no validated yoga modules for treating/managing hypothyroid condition. Aim: To develop an integrated yoga module for hypothyroidism. Materials and Methods: Integrated yoga module has been designed based on traditional yoga literature and expert opinion. Based on the pancha kosha model (five layered existence), 53 yogic techniques were compiled and sent to 36 experts for content and face validation. Experts validated each technique by rating the relevance on a five point likert scale. Validated techniques were administered to a group of 35 women having hypothyroidism to assertain acceptance and the possibility of practice of said techniques. Content Validity Ratio (CVR) and the average of mean, mode and median of scores were calculated. Data analysis was done using Statistical Package for the Social Sciences (SPSS) software version 23. Results: Out of the 53 techniques, 41 techniques scored either CVR more than 0.5 or average of mean, median and mode more than 4. Conclusion: The developed integrated yoga module for hypothyroidism enjoys good face and content validity. Initial feasibility test confirms that the techniques are accepted and could be practiced by the hypothyroid patients. Further validation of the module using a pre-post study is warranted to confirm its efficacy.
... [5][6][7][8] Though experience shows that yoga may have a role in revitalizing thyroid function there are few empirical studies on the effects of yoga on thyroid disorders. 9 Singh et al. (2010) studied and concluded noticeable impact of Yoga on hypothyroidism of women. 10 A study by Nilakanthan et al (2016) of six months of yoga practice on women participants (1 hour daily for 4 days a week) showed significant reduction in total cholesterol, lowdensity lipoprotein (LDL) and triglycerides, a significant improvement in high-density lipoprotein (HDL) along with reduction in TSH level and significant reduction in thyroxin medication. ...
... 10 A study by Nilakanthan et al (2016) of six months of yoga practice on women participants (1 hour daily for 4 days a week) showed significant reduction in total cholesterol, lowdensity lipoprotein (LDL) and triglycerides, a significant improvement in high-density lipoprotein (HDL) along with reduction in TSH level and significant reduction in thyroxin medication. 11 Bhavanani (2011) concluded that after one year of yoga therapy, there was a fall in TSH (2.66 mIU/L) and a normalization of free T4 values (8.98pmol/L). 9 A third biochemical analysis three months later showed that TSH further stabilized 2mIU/L and FT4 at 9.78 pmol/L. ...
... 11 Bhavanani (2011) concluded that after one year of yoga therapy, there was a fall in TSH (2.66 mIU/L) and a normalization of free T4 values (8.98pmol/L). 9 A third biochemical analysis three months later showed that TSH further stabilized 2mIU/L and FT4 at 9.78 pmol/L. Encouraged by the results of an analysis and review of the YPV case summaries presented in Table 1 (see Annexure) and considerable field experience gained in YPV healing and monitoring the patients, the authors are presenting two cases (one female and one male) in this case report as examples of how Hypothyroidism was successfully healed by Yoga Prana Vidya (YPV) as complementary medicine. ...
Article
Full-text available
Background: This case study reviewed cases of hypothyroidism healed successfully using Yoga Prana Vidya (YPV) Healing system working as complementary medicine, and explored the underpinning science that explains the phenomenon. Materials and Methods: This is a case study method, going through full detailed records of one 49 year old female patient and one 59 year old male patient, diagnosed as having Hypothyroidism, examining their health conditions pre and post YPV healing system observed through lab reports, as well as data collected from follow-up interviews of the subjects. Results: Analysis of the cases shows positive results of improvement obtained with use of YPV healing methods by healers and also use of some self-healing techniques by the patients, enabling them to have controlled level of Hypothyroidism and overall health. Conclusions: There is primafacie evidence to show that YPV is effective in healing and treating thyroid condition, besides healing some other ailments of the patient holistically. To produce holistic and optimum results, YPV uses a combination of approaches such as, (1) physical exercises including rhythmic yogic breathing, (2) Salt free diet; fruit diet, (3) Meditation techniques, (4) healing by trained and experienced healers, patient participation in group healing, self-healing by patients with regular self-practice of some specified techniques. There is ample scope to conduct further research on the application of YPV as alternative, effective and low cost medicine for various medical conditions. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC license (https://creativecommons.org/licenses/by-nc/4.0/)
... The practice of Yogasanas has been found successful in maintaining low Glycemic index in diabetics [29] and hence the incidence of Adhesive Capsulitis may be controlled. Having the systemic cause for AC next to Diabetes is Hypothyroidism, supervised and graduated yogic practices with pranayama can yield a better clinical and a functional outcome along with the medical management [30]. ...
Article
Full-text available
Background: Adhesive capsulitis (AC) of shoulder is a common condition encountered by physical therapists in their routine outpatient care services; AC of shoulder is as by itself being a self limiting disorder lasts from months to years causing pain and discomfort to the patients. The condition is commonly associated with Diabetes mellitus or other co morbidities. The incidence of AC is high among diabetic individuals and it becomes mandatory on the part of physical therapists and other health professionals to approach this issue on a holistic manner. This paper deals with the importance of a physiotherapist role in prevention and dealing with the causative factors of AC and not merely its symptom. Methods: Extensive literature review was done from the electronic data bases, Systematic reviews and critical reviews from Pub med indexed journals and other peer reviewed publications across the globe. Results: It was not the type of diabetes but the duration of the disease and the glycemic index, marking the causative factor for adhesive capsulitis of shoulder. Conclusion: It may be concluded that physiotherapist play a vital role in identifying the pre-diabetic or a diabetic state of an individual reporting in a multi disciplinary set up with a AC of shoulder, and also has a role in the prevention of AC by helping the individual to maintain a good glycemic control with a holistic approach which includes aerobic exercises, General Flexibility exercises, Weight management and Yoga therapy.
Article
Full-text available
Introduction: Menopause is a transitional phase in which some women experience discomfort, while others may exhibit variety of symptoms. The power of yoga therapy in relieving stress, enhancing health, improving fitness and managing symptoms of a variety of disorders is remarkable. Aim: The current study was designed to study the effect of Hatha yoga therapy and regular physical exercise on the Fasting Blood Sugar (FBS), Glycated Haemoglobin (GHB), Thyroid Stimulating Hormone (TSH), serum cortisol and total plasma thiol levels in perimenopausal women. Materials and methods: The study included 216 women with perimenopausal symptoms, 111 in test group (Hatha yoga) and 105 in control group (physical exercise). The duration of intervention was 45 minutes every day for 12 weeks. Blood samples were collected in the pre and post intervention period. Statistical significance was defined as p<0.05. Results: FBS and GHB (p≤0.05) showed a significant decrease after yoga therapy. Cortisol levels significantly (p≤0.05) increased in the post intervention period in the control group. However, it is maintained in the test group between the two time periods. The total plasma thiols level showed a rise in the post intervention period, significant rise (p≤0.001) in control group but not significant in the test group. The TSH levels were not altered in any group. Conclusion: It is concluded that exercise helps in maintaining the sugar levels but calming effects of yoga practice is important in relieving stress and enhancing health in perimenopausal women.
Article
Full-text available
The Advanced Centre for Yoga Therapy Education and Research (ACYTER), a collaborative venture between JIPMER, Puducherry and Morarji Desai National Institute of Yoga (MDNIY), New Delhi was established by an MOU between JIPMER and MDNIY in June 2008 and is focusing primarily on the role of Yoga in the prevention and management of cardiovascular disorders and diabetes mellitus. More than 36,000 patients have benefited from Yoga therapy consultation and attended therapy individual and group sessions in the past four years and a detailed survey has also been published based on feedback from patients. With the active collaboration of MDNIY, New Delhi many research projects are being conducted at JIPMER as collaborative efforts between ACYTER and the Departments of Physiology, Medicine, Biochemistry and Cardiology. This paper summarizes some of the important findings from 12 research works at ACYTER between 2008 and 2012 that provide evidence of the therapeutic potential of Yoga. These can provide a basis for further studies exploring the physiological, psychological and biochemical mechanisms such beneficial effects.
Article
Full-text available
This study evaluated the effect of physiological, TSH-guided, L-thyroxine treatment on serum lipids and clinical symptoms in patients with subclinical hypothyroidism. Sixty-six women with proven subclinical hypothyroidism (TSH, 11.7 +/- 0.8 mIU/liter) were randomly assigned to receive L-thyroxine or placebo for 48 wk. Individual L-thyroxine replacement (mean dose, 85.5 +/- 4.3 microg/d) was performed based on blinded TSH monitoring, resulting in euthyroid TSH levels (3.1 +/- 0.3 mIU/liter). Lipid concentrations and clinical scores were measured before and after treatment. Sixty-three of 66 patients completed the study. In the L-thyroxine group (n = 31) total cholesterol and low density lipoprotein cholesterol were significantly reduced [-0.24 mmol/liter, 3.8% (P = 0.015) and -0.33 mmol/liter, 8.2% (P = 0.004), respectively]. Low density lipoprotein cholesterol decrease was more pronounced in patients with TSH levels greater than 12 mIU/liter or elevated low density lipoprotein cholesterol levels at baseline. A significant decrease in apolipoprotein B-100 concentrations was observed (P = 0.037), whereas high density lipoprotein cholesterol, triglycerides, apolipoprotein AI, and lipoprotein(a) levels remained unchanged. Two clinical scores assessing symptoms and signs of hypothyroidism (Billewicz and Zulewski scores) improved significantly (P = 0.02). This is the first double blind study to show that physiological L-thyroxine replacement in patients with subclinical hypothyroidism has a beneficial effect on low density lipoprotein cholesterol levels and clinical symptoms of hypothyroidism. An important risk reduction of cardiovascular mortality of 9-31% can be estimated from the observed improvement in low density lipoprotein cholesterol.
Article
Full-text available
Systolic time intervals (STI) are non-invasive and sensitive tests for measuring the ventricular performance. It has been reported that practice of pranayam modulates cardiac autonomic status and improves cardio-respiratory functions. Keeping this in view, the present study was designed to determine whether pranayam training has any effect on ventricular performance as measured by STI and cardiac autonomic function tests (AFT). Twenty four school children were randomly divided into two groups of twelve each. Group I (pranayam group) subjects were given training in nadishuddhi, mukh-bhastrika, pranav and savitri pranayams and practiced the same for 20 minutes daily for a duration of 3 months. Group II (control group) subjects were not given any pranayam training. STI (QS2, LVET and PEP) and AFT (RRIV and QT/QS2) were measured in both the groups at the beginning and again at the end of three months study period. Pranayam training produced an increase in RRIV and a decrease in QT/QS2, suggesting an enhanced parasympathetic and blunted sympathetic activity respectively. QS2, PEP and PEP/LVET increased significantly, whereas LVET was reduced significantly in pranayam group. In contrast, the changes in STI and AFT were much less marked in the control group. Our study shows that three months of pranayam training modulates ventricular performance by increasing parasympathetic activity and decreasing sympathetic activity. Further studies on a larger sample size may illustrate the underlying mechanism(s) involved in this alteration.
Article
Full-text available
Although yoga is historically a spiritual discipline, it has also been used clinically as a therapeutic intervention. A bibliometric analysis on the biomedical journal literature involving research on the clinical application of yoga has revealed an increase in publication frequency over the past 3 decades with a substantial and growing use of randomized controlled trials. Types of medical conditions have included psychopathological (e.g. depression, anxiety), cardiovascular (e.g. hypertension, heart disease), respiratory (e.g. asthma), diabetes and a variety of others. A majority of this research has been conducted by Indian investigators and published in Indian journals, particularly yoga specialty journals, although recent trends indicate increasing contributions from investigators in the U.S. and England. Yoga therapy is a relatively novel and emerging clinical discipline within the broad category of mind-body medicine, whose growth is consistent with the burgeoning popularity of yoga in the West and the increasing worldwide use of alternative medicine.
Article
Full-text available
Considerable evidence exists for the place of mind body medicine in the treatment of anxiety disorders. Excessive anxiety is maladaptive. It is often considered to be the major component of unhealthy lifestyle that contributes significantly to the pathogenesis of not only psychiatric but also many other systemic disorders. Among the approaches to reduce the level of anxiety has been the search for healthy lifestyles. The aim of the study was to study the short-term impact of a comprehensive but brief lifestyle intervention, based on yoga, on anxiety levels in normal and diseased subjects. The study was the result of operational research carried out in the Integral Health Clinic (IHC) at the Department of Physiology of All India Institute of Medical Sciences. The subjects had history of hypertension, coronary artery disease, diabetes mellitus, obesity, psychiatric disorders (depression, anxiety, 'stress'), gastrointestinal problems (non ulcer dyspepsia, duodenal ulcers, irritable bowel disease, Crohn's disease, chronic constipation) and thyroid disorders (hyperthyroidism and hypothyroidism). The intervention consisted of asanas, pranayama, relaxation techniques, group support, individualized advice, and lectures and films on philosophy of yoga, the place of yoga in daily life, meditation, stress management, nutrition, and knowledge about the illness. The outcome measures were anxiety scores, taken on the first and last day of the course. Anxiety scores, both state and trait anxiety were significantly reduced. Among the diseased subjects significant improvement was seen in the anxiety levels of patients of hypertension, coronary artery disease, obesity, cervical spondylitis and those with psychiatric disorders. The observations suggest that a short educational programme for lifestyle modification and stress management leads to remarkable reduction in the anxiety scores within a period of 10 days.
Article
Purpose: The role of thyroxine replacement in subclinical hypothyroidism remains unclear. We performed a 6-month randomized, double-blind, placebo-controlled trial to evaluate the effects of thyroxine treatment for mild subclinical hypothyroidism, defined as a serum thyroid-stimulating hormone level between 5 to 10 microU/mL with a normal serum free thyroxine level (0.8-16 ng/dL). Subjects and methods: We randomly assigned 40 women with mild subclinical hypothyroidism who had presented to their family practitioners to either thyroxine treatment (n = 23; 50 to 100 microg daily) or placebo (n = 17). Health-related quality of life (Hospital Anxiety and Depression scale, 30-item General Health Questionnaire), fasting lipid profiles, body weight, and resting energy expenditure were measured at baseline and 6 months. Results: The most common presenting symptoms were fatigue (n = 33 [83%]) and weight gain (n = 32 [80%]). At presentation, 20 women (50%) had elevated anxiety scores and 22 (56%) had elevated scores on the General Health Questionnaire. Thirty-five women completed the study. There were no significant differences in the changes from baseline to 6 months between women in the thyroxine group and the placebo group for any of the metabolic, lipid, or anthropometric variables measured, expressed as the mean change in the thyroxine group minus the mean change in the placebo group: body mass index, -0.3 kg/m(2) (95% confidence interval [CI]: -0.9 to 0.4 kg/m(2)); resting energy expenditure, -0.2 kcal/kg/24 h (95% CI: -1.3 to 1.0 kcal/kg/24 h); and low-density lipoprotein cholesterol, -4 mg/dL (95% CI: -23 to 15 mg/dL). There was a significant worsening in anxiety scores in the thyroxine group (scores increased in 8 of 20 women and were unchanged in 2 of 20) compared with the placebo group (scores increased in 1 of 14 women and were unchanged in 6 of 14; P = 0.03). CONCLUSIONS; We observed no clinically relevant benefits from 6 months of thyroxine treatment in women with mild subclinical hypothyroidism.
Article
Left ventricular performance was studied in 15 patients with severe, primary hypothyroidism (mean serum total thyroxine of 0.8 mug per 100 ml and serum thyrotropin of 160 muU per milliliter). Pretreatment systolic-time intervals were characterized by prolongation of the pre-ejection period (delta PEP = +30) and reduction of the left ventricular ejection period (delta LVET = -23) with a resultant increase in the PEP/LVET ratio (0.47). Nine of 14 patients demonstrated pericardial effusions. These abnormalities were reversed with physiologic thyroxine replacement. Further reductions of the delta PEP and PEP/LVET ratio occurred with supraphysiologic doses (200 to 300 mug per day). During therapy, delta PEP was inversely correlated with serum thyroxine (P less than 0.001) and directly correlated with serum thyrotropin (P less than 0.001). Thus physiologic thyroid hormone replacement, appropriately adjusted to need, appears necessary in hypothyroidism for optimal left ventricular function.
Article
The effects of exercise and beta adrenoceptor blockade on left ventricular function were assessed in eight patients with hypothyroidism before and during thyroxine replacement treatment. Left ventricular ejection fraction, measured by radionuclide ventriculography, was reduced in hypothyroid patients at rest and on exercise. The rise in ejection fraction with exercise was, however, similar in both groups. Pretreatment with intravenous propranolol reduced the ejection fraction at rest 9% in both hypothyroid and euthyroid patients and reduced the rise on exercise. Directional changes in a second index of myocardial contractility based on the shape of the ventricular volume curve paralleled the changes in the ejection fraction. Left ventricular function is therefore reversibly depressed by thyroid hormone deficiency but responses to exercise and beta adrenoceptor blockade are normal. There is no evidence of altered adrenergic sensitivity in the control of myocardial contractility in hypothyroidism.
Article
Using radioactive iodine, the effect of 1 month's yogic exercises has been investigated on the thyroid function of subjects resident at sea level (SL) specially after their exposure to high altitude (HA). The results have been compared with a group of SL subjects who underwent physical training (PT) exercises for the same duration. Ten healthy male volunteers in the age range of 20-30 years were used as test subjects in this study with each serving as his own control. The subjects were randomly divided into two groups of 5 each. One group practised hatha yogic exercises, while the other group performed the regular PT exercises. The thyroidal accumulation and release of radioactive iodine have been measured in each of the subjects of both groups before and after 1 month of their respective exercises at SL. One month of yogic exercises at SL has been observed to cause a significant reduction in the trans-thyroidal availability of radioiodine. The thyroid radioactivity in this group of subjects was always below normal levels with the exception of two peaks of radioactive iodine uptake, when the levels of radioactivity in the thyroid were similar to the control values of pre-yogic exercises. The release of radiolabel at 24-48 h was significantly increased after yogic exercises. In contrast, the subjects performing PT exercises for the same duration at SL showed significant thyroid uptake of radioactive iodine at 24 h. Subsequently their 131I uptake continued to rise slowly until 72 h without any demonstrable thyroidal release of radiolabel. This indicated that increased thyroid activity was induced by conventional PT exercise.(ABSTRACT TRUNCATED AT 250 WORDS)
Forty eight healthy volunteers who participated in the practice of yoga over a period of 4 months were assessed on Subjective Well Being Inventory (SUBI) before and after the course in order to evaluate the effect of practice of yoga on subjective feelings of well-being and quality of life. A significant improvement in 9 of the 11 factors of SUBI was observed at the end of 4 months, in these participants. The paper thus, reiterates the beneficial effects of regular practice of yoga on subjective well being.