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Licensed Unlicensed Requires Authentication Published by De Gruyter August 10, 2020

Update of hypothyroidism and its management in Unani medicine

  • Md. Anzar Alam ORCID logo EMAIL logo , Mohd Aleemuddin Quamri , Ghulamuddin Sofi and Shabnam Ansari

Abstract

Hypothyroidism is a clinical syndrome caused by thyroid hormone deficiency due to reduced production, deranged distribution, or lack of effects of thyroid hormone. The prevalence of hypothyroidism in developed countries is around 4–5%, whereas it is about 11% in India, only 2% in the UK, and 4·6% in the USA. It is more common in women than in men. Hypothyroidism has multiple etiologies and manifestations. The most common clinical manifestations are weight gain, loss of hair, cold intolerance, lethargy, constipation, dry skin, and change in voice. The signs and symptoms of hypothyroidism differ with age, gender, severity of condition, and some other factors. The diagnosis is based on clinical history, physical examination and serum level of FT3, FT4, and thyroid-stimulating hormone, imaging studies, procedures, and histological findings. The treatment of choice for hypothyroidism is levothyroxine, however; in this review article, we have discussed the epidemiology, etiology, clinical sign and symptoms, diagnosis, complications, and management of hypothyroidism in modern medicine and a comparative treatment by the Unani system of medicine (USM). In the USM, the main emphasis of the principle of treatment (Usool-e-Ilaj) is to correct the abnormal constitution (Su-e-Mizaj) and alter the six prerequisites for existence (Asbab-e-Sitta Zarooriya) to restore normal health. It is a packaged treatment, that is, different components of treatment are given as a package form which includes different drugs, dosages form, and regimens.

Highlights

  1. The concept of hypothyroidism has evolved over the centuries. It has been reported to be a woman-centric disorder.

  2. There are several new subclasses of hypothyroidism based on the site of the lesion.

  3. Levothyroxine has remained the treatment of choice. There has been little progress in managing the disorder.

  4. The Unani system of medicine has been treating various manifestations of the disease since centuries with the help of crude drugs of herbal, animal, or mineral origin.

  5. This review updates the concept and various dimensions of the disease hypothyroidism.

  6. This review has enlisted new modalities for reducing the risk of hypothyroidism as stated in the literature of Unani medicine.


Corresponding author: Md. Anzar Alam, PhD Scholar,Department of Moalajat, National Institute of Unani Medicine, Bangalore, 560091, India, Mobile: +91 9916164662, E-mail:

Acknowledgments

The authors express thanks to Library staffs of National Institute of Unani Medicine (NIUM) Bangalore for providing the materials of this conceptual article.

  1. Research funding: There is no financial support in this study.

  2. Author contributions: All authors have accepted responsibility for the entire content of this article and approved its submission.

  3. Competing interests: The authors declare that they have no competing interests.

References

1. Ron, E, Brenner, A. Non-malignant thyroid diseases after a wide range of radiation exposures. Radiat Res 2010;174:877–88. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/21128812. https://doi.org/10.1667/rr1953.1.Search in Google Scholar

2. Das, KV, Poulose, KP. Thyroid and its disorders. textbook of medicine, 5th ed. New Delhi: Jaypee Publishers Limited; 2008:625–41 pp.10.5005/jp/books/10921_98Search in Google Scholar

3. Sembulingam, K, Sembulingam, P. Thyroid gland. Essential of medical physiology, 6th ed. New Delhi: Jaypee Publishers Limited; 2012:388–94 pp.10.5005/jp/books/11696_145Search in Google Scholar

4. Pirahanchi, Y, Jialal, I. Physiology, thyroid stimulating hormone (TSH). Treasure Island (FL): StatPearls Publishing; 2019. [Pubmed] https://www.ncbi.nlm.nih.gov/books/NBK499850/.Search in Google Scholar

5. Grigorova, M, Sherwin, BB. Thyroid hormones and cognitive functioning in healthy, euthyroid women: a correlational study. Horm Behav 2012;61:617–22. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/22373496. https://doi.org/10.1016/j.yhbeh.2012.02.014.Search in Google Scholar

6. Hennemann, G, Docter, R, Friesema, EC, de Jong, M, Krenning, EP, Visser, TJ. Plasmamembrane transport of thyroid hormones and its role in thyroid hormone metabolism and bioavailability. Endocr Rev 2001;22:451–76. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/11493579. https://doi.org/10.1210/edrv.22.4.0435.Search in Google Scholar

7. Sellitti, DF, Suzuki, K. Intrinsic regulation of thyroid function by thyroglobulin. Thyroid 2014;24:625–38. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24251883. https://doi.org/10.1089/thy.2013.0344.Search in Google Scholar

8. Chung, HR. Iodine and thyroid function. Ann Pediatr Endocrinol Metab 2014;19:8–12. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24926457. https://doi.org/10.6065/apem.2014.19.1.8.Search in Google Scholar

9. Chi, HC, Chen, CY, Tsai, MM, Tsai, CY, Lin, KH. Molecular functions of thyroid hormones and their clinical significance in liver-related diseases. BioMed Res Int 2013;2013:601361. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/23878812. https://doi.org/10.1155/2013/601361.Search in Google Scholar

10. Moog, NK, Entringer, S, Heim, C, Wadhwa, PD, Kathmann, N, Buss, C. Influence of maternal thyroid hormones during gestation on fetal brain development. Neuroscience 2017;342:68–100. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/26434624. https://doi.org/10.1016/j.neuroscience.2015.09.070.Search in Google Scholar

11. Sahay, RK, Nagesh, VS. Hypothyroidism in pregnancy. Indian J Endocrinol Metab 2012;16:364–70. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/22629500. https://doi.org/10.4103/2230-8210.95667.Search in Google Scholar

12. Patil, N, Jialal, I. Hypothyroidism. StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2019. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/30137821.Search in Google Scholar

13. Chakera, AJ, Pearce, SH, Vaidya, B. Treatment for primary hypothyroidism: current approaches and future possibilities. Drug Des Dev Ther 2012;6:1–11. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/22291465.10.2147/DDDT.S12894Search in Google Scholar

14. Chaker, L, Bianco, AC, Jonklaas, J, Peeters, RP. Hypothyroidism. Lancet 2017;390:1550–62. [pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28336049. https://doi.org/10.1016/s0140-6736(17)30703-1.Search in Google Scholar

15. Cappelli, C, Castello, R, Marini, F, Paoletta, A, Marchetti, M, Saullo, M. Adherence to levothyroxine treatment among patients with hypothyroidism: a northeastern Italian survey. Front Endocrinol 2018;9:699. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/30532737. https://doi.org/10.3389/fendo.2018.00699.Search in Google Scholar

16. Thvilum, M, Brandt, F, Almind, D, Christensen, K, Hegedüs, L, Brix, TH. Excess mortality in patients diagnosed with hypothyroidism: a nationwide cohort study of singletons and twins. J Clin Endocrinol Metab 2013;98:1069–75. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/23365121. https://doi.org/10.1210/jc.2012-3375.Search in Google Scholar

17. Sethi, B, Barua, S, Raghavendra, MS, Gotur, J, Khandelwal, D, Vyas, U. The thyroid registry: clinical and hormonal characteristics of adult Indian patients with hypothyroidism. Indian J Endocrinol Metab 2017;21:302–7. [pubmed] www.ncbi.nlm.nih.gov/pubmed/28459030.10.4103/ijem.IJEM_387_16Search in Google Scholar

18. Nair, A, Jayakumari, C, Jabbar, PK, Jayakumar, RV, Raizada, N, Gopi, A, et al. Prevalence and associations of hypothyroidism in Indian patients with type 2 diabetes mellitus. J Thyroid Res 2018;2018:5386129. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/30174822.10.1155/2018/5386129Search in Google Scholar

19. Bagcchi, S. Hypothyroidism in India: more to be done. Lancet Diabetes Endocrinol 2014;2:778. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/25282085. https://doi.org/10.1016/s2213-8587(14)70208-6.Search in Google Scholar

20. Unnikrishnan, AG, Kalra, S, Sahay, RK, Bantwal, G, John, M, Tewari, N. Prevalence of hypothyroidism in adults: an epidemiological study in eight cities of India. Indian J Endocrinol Metab 2013;17:647–52. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/23961480. https://doi.org/10.4103/2230-8210.113755.Search in Google Scholar

21. Kim, YA, Park, YJ. Prevalence and risk factors of subclinical thyroid disease. Endocrinol Metab (Seoul) 2014;29:20–9. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24741450. https://doi.org/10.3803/enm.2014.29.1.20.Search in Google Scholar

22. Khatiwada, S, Kc, R, Sah, SK, Khan, SA, Chaudhari, RK, Baral, N, et al. ThyroidDysfunction and associated risk factors among Nepalese diabetes mellitus patients. Internet J Endocrinol 2015;2015:570198. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/26435714. https://doi.org/10.1155/2015/570198.Search in Google Scholar

23. Al-Geffari, M, Ahmad, NA, Al-Sharqawi, AH, Youssef, AM, Alnaqeb, D, Al-Rubeaan, K. Risk factors for thyroid dysfunction among type 2 diabetic patients in a highly diabetes mellitus prevalent society. Internet J Endocrinol 2013;2013:417920. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24454365. https://doi.org/10.1155/2013/417920.Search in Google Scholar

24. Bajaj, JK, Salwan, P, SalwanS. Various possible toxicants involved in thyroid dysfunction: a review. J Clin Diagn Res 2016;10:FE01–3. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/26894086.10.7860/JCDR/2016/15195.7092Search in Google Scholar PubMed PubMed Central

25. Sami, A, Iftekhar, MF, Rauf, MA, Sher, A. Subclinical hypothyroidism among local adult obese population. Pak J Med Sci 2018;34:980–3. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/30190765. https://doi.org/10.12669/pjms.344.14127.Search in Google Scholar

26. Patil, AD. Link between hypothyroidism and small intestinal bacterial overgrowth. Indian J Endocrinol Metab 2014;18:307–9. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24944923. https://doi.org/10.4103/2230-8210.131155.Search in Google Scholar

27. Taylor, PN, Albrecht, D, Scholz, A, Gutierrez-Buey, G, Lazarus, JH, Dayan, CM. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol 2018;14:301–16. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/29569622. https://doi.org/10.1038/nrendo.2018.18.Search in Google Scholar

28. Paul, J, Dasgupta, S. Co-morbidities in hypothyroid patients in a tertiary health care hospital in India. Thyroid Disorders Ther 2012;1:106. https://doi.org/10.4172/2167-7948.1000106.Search in Google Scholar

29. Almandoz, JP, Gharib, H. Hypothyroidism: etiology, diagnosis, and management. Med Clin 2012;96:203–21. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/22443971. https://doi.org/10.1016/j.mcna.2012.01.005.Search in Google Scholar

30. Sheehan, MT. Biochemical testing of the thyroid: TSH is the best and, oftentimes, only test needed – a review for primary care. Clin Med Res 2016;14:83–92. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/27231117. https://doi.org/10.3121/cmr.2016.1309.Search in Google Scholar

31. Mithal, A, Dharmalingam, M, Tewari, N. Are patients with primary hypothyroidism in India receiving appropriate thyroxine replacement? An observational study. Indian J Endocrinol Metab 2014;18:83–8. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24701435. https://doi.org/10.4103/2230-8210.126582.Search in Google Scholar

32. Kostoglou-Athanassiou, I, Ntalles, K. Hypothyroidism–new aspects of an old disease. Hippokratia 2010;14:82–7. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/20596261.10.5772/intechopen.95721Search in Google Scholar

33. Qari, F. Hypothyroidism in clinical practice. J Fam Med Prim Care 2014;3:98–101. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/25161963. https://doi.org/10.4103/2249-4863.137609.Search in Google Scholar

34. Miyake, Z, Ishii, K, Tamaoka, A. Hypothyroidism induced by phenytoin and gabapentin: a case report. Medicine (Baltim) 2018;97:e12938. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/30412107. https://doi.org/10.1097/md.0000000000012938.Search in Google Scholar

35. Larouche, V, Snell, L, Morris, DV. Iatrogenic myxoedema madness following radioactive iodine ablation for Graves’ disease, with a concurrent diagnosis of primary hyperaldosteronism. Endocrinol Diabetes Metab Case Rep 2015;2015:150087. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/26525086. https://doi.org/10.1530/edm-15-0087.Search in Google Scholar

36. Alfadda, AA, Sallam, RM, Elawad, GE, Aldhukair, H, Alyahya, MM. Subacute thyroiditis: clinical presentation and long term outcome. Internet J Endocrinol 2014;2014:794943. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24803929. https://doi.org/10.1155/2014/794943.Search in Google Scholar

37. Ferrari, SM, Fallahi, P, Antonelli, A, Benvenga, S. Environmental issues in thyroid diseases. Front Endocrinol 2017;8:50. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28373861. https://doi.org/10.3389/fendo.2017.00050.Search in Google Scholar

38. Tng, EL. The debate on treating subclinical hypothyroidism. Singap Med J 2016;57:539–45. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/27779276.10.11622/smedj.2016165Search in Google Scholar PubMed PubMed Central

39. Cojić, M, Cvejanov-Kezunović, L. Subclinical hypothyroidism - whether and when to start treatment?. Open Access Maced J Med Sci 2017;5:1042–6. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/29362642.10.3889/oamjms.2017.195Search in Google Scholar PubMed PubMed Central

40. Redford, C, Vaidya, B. Subclinical hypothyroidism: should we treat?. Post Reprod Health 2017;23:55–62. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28406057. https://doi.org/10.1177/2053369117705058.Search in Google Scholar

41. Gosi, SKY, Garla, VV. Subclinical hypothyroidism. Treasure Island (FL): StatPearls Publishing; 2019. [Pubmed] https://www.ncbi.nlm.nih.gov/books/NBK536970/.Search in Google Scholar

42. Beck-Peccoz, P, Rodari, G, Giavoli, C, Lania, A. Central hypothyroidism – a neglected thyroid disorder. Nat Rev Endocrinol 2017;13:588–98. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28549061. https://doi.org/10.1038/nrendo.2017.47.Search in Google Scholar

43. Gupta, V, Lee, M. Central hypothyroidism. Indian J Endocrinol Metab 2011;15:S99–106. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/21966662. https://doi.org/10.4103/2230-8210.83337.Search in Google Scholar

44. Grunenwald, S, Caron, P. Central hypothyroidism in adults: better understanding for better care. Pituitary 2015;18:169–75. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24554165. https://doi.org/10.1007/s11102-014-0559-8.Search in Google Scholar

45. Persani, L, Bonomi, M. The multiple genetic causes of central hypothyroidism. Best Pract Res Clin Endocrinol Metabol 2017;31:255–63. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28648512. https://doi.org/10.1016/j.beem.2017.04.003.Search in Google Scholar

46. Weber Pasa, M, Selbach Scheffel, R, Borsatto Zanella, A, Maia, AL, Dora, JM. Consumptive hypothyroidism: case report of hepatic hemangioendotheliomas successfully treated with vincristine and systematic review of the syndrome. Eur Thyroid J 2017;6:321–7. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/29234626.10.1159/000481253Search in Google Scholar PubMed PubMed Central

47. Huang, SA. Physiology and pathophysiology of type 3 deiodinase in humans. Thyroid 2005;15:875–81. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/16131330. https://doi.org/10.1089/thy.2005.15.875.Search in Google Scholar

48. Luongo, C, Trivisano, L, Alfano, F, Salvatore, D. Type 3 deiodinase and consumptive hypothyroidism: a common mechanism for a rare disease. Front Endocrinol 2013;4:115. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24027558. https://doi.org/10.3389/fendo.2013.00115.Search in Google Scholar

49. Feingold, KR, Anawalt, B, Boyce, A, Chrousos, G, Dungan, K, Grossman, A, et al. Adult hypothyroidism. South Dartmouth (MA): MDText.com, Inc.; 2000. [Pubmed] https://www.ncbi.nlm.nih.gov/books/NBK285561/.Search in Google Scholar

50. Kalra, S, Ganie, MA, Unnikrishnan, AG. Overt hypothyroidism in pregnancy: can we consider medical termination of pregnancy?. Indian J EndocrMetab 2013;17:197–9. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/23776888. https://doi.org/10.4103/2230-8210.109655.Search in Google Scholar

51. Raza, SA, Mahmood, N. Subclinical hypothyroidism: controversies to consensus. Indian J Endocrinol Metab 2013;17:S636–42. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24910826. https://doi.org/10.4103/2230-8210.123555.Search in Google Scholar

52. Khandelwal, D, Tandon, N. Overt and subclinical hypothyroidism: who to treat and how. Drugs 2012;72:17–33. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/22191793. https://doi.org/10.2165/11598070-000000000-00000.Search in Google Scholar

53. Alam, MA, Quamri, MA, Sofi, G, Tarique, BM. Understanding hypothyroidism in Unani medicine. J Integrat Med 2019;17:387–91. https://doi.org/10.1016/j.joim.2019.05.006. https://doi.org/10.1016/j.joim.2019.05.006.Search in Google Scholar

54. Cyriac, S, d’Souza, SC, Lunawat, D, Shivananda, P, Swaminathan, M. A classic sign of hypothyroidism: a video demonstration. CMAJ (Can Med Assoc J) 2008;179:387. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/18695193. https://doi.org/10.1503/cmaj.070318.Search in Google Scholar

55. Grais, IM, Sowers, JR. Thyroid and the heart. Am J Med 2014;127:691–8. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24662620. https://doi.org/10.1016/j.amjmed.2014.03.009.Search in Google Scholar

56. Sadek, SH, Khalifa, WA, Azoz, AM. Pulmonary consequences of hypothyroidism. Ann Thorac Med 2017;12:204–8. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28808493. https://doi.org/10.4103/atm.atm_364_16.Search in Google Scholar

57. Daher, R, Yazbeck, T, Jaoude, JB, Abboud, B. Consequences of dysthyroidism on the digestive tract and viscera. World J Gastroenterol 2009;15:2834–8. https://doi.org/10.3748/wjg.15.2834. https://doi.org/10.3748/wjg.15.2834.Search in Google Scholar

58. Stasiolek, M. Neurological symptoms and signs in thyroid disease. Thyroid Res 2015;8:A25. [PMC] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480949/. https://doi.org/10.1186/1756-6614-8-s1-a25.Search in Google Scholar

59. Gupta, N1, Arora, M, Sharma, R, Arora, KS. Peripheral and central nervous system involvement in recently diagnosed cases of hypothyroidism: an electrophysiological study. Ann Med Health Sci Res 2016;6:261–6. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28503341. https://doi.org/10.4103/amhsr.amhsr_39_16.Search in Google Scholar

60. Gietka-Czernel, M. The thyroid gland in postmenopausal women: physiology and diseases. Prz Menopauzalny 2017;16:33–7. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28721126. https://doi.org/10.5114/pm.2017.68588.Search in Google Scholar

61. Nandi-Munshi, D, Taplin, CE. Thyroid-related neurological disorders and complications in children. Pediatr Neurol 2015;52:373–82. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/25661286. https://doi.org/10.1016/j.pediatrneurol.2014.12.005.Search in Google Scholar

62. Hari Kumar, KV, Garg, A, Ajai Chandra, NS, Singh, SP, Datta, R. Voice and endocrinology. Indian J Endocrinol Metab 2016;20:590–4. https://doi.org/10.4103/2230-8210.190523.Search in Google Scholar

63. Malik, V, Shukla, GK, Bhatia, N. Hearing profile in hypothyroidism. Indian J Otolaryngol Head Neck Surg 2002;54:285–90. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/23119912.10.1007/BF02993744Search in Google Scholar PubMed PubMed Central

64. Keen, MA, Hassan, I, Bhat, MH. A clinical study of the cutaneous manifestations of hypothyroidism in kashmir valley. Indian J Dermatol 2013;58:326. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/23919021.10.4103/0019-5154.113951Search in Google Scholar PubMed PubMed Central

65. Carlé, A, Pedersen, IB, Knudsen, N, Perrild, H, Ovesen, L, Laurberg, P. Hypothyroid symptoms and the likelihood of overt thyroid failure: a population-based case-control study. Eur J Endocrinol 2014;171:593–602. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/25305308. https://doi.org/10.1530/eje-14-0481.Search in Google Scholar

66. Salvatore, D, Simonides, WS, Dentice, M, Zavacki, AM, Larsen, PR. Thyroid hormones and skeletal muscle--new insights and potential implications. Nat Rev Endocrinol 2014;10:206–14. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/24322650. https://doi.org/10.1038/nrendo.2013.238.Search in Google Scholar

67. Priya, DM, Akhtar, N, Ahmad, J. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Indian J Endocrinol Metab 2015;19:504–6. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/26180766.10.4103/2230-8210.159058Search in Google Scholar PubMed PubMed Central

68. Cho, MK. Thyroid dysfunction and subfertility. Clin Exp Reprod Med 2015;42:131–5. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/26816871. https://doi.org/10.5653/cerm.2015.42.4.131.Search in Google Scholar

69. Urmi, SJ, Begum, SR, Fariduddin, M, Begum, SA, Mahmud, T, Banu, J, et al. Hypothyroidism and its effect on menstrual pattern and fertility. Mymensingh Med J 2015;24:765–9. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/26620017.Search in Google Scholar

70. Ajmani, NS, Sarbhai, V, Yadav, N, Paul, M, Ahmad, A, Ajmani, AK. Role of thyroid dysfunction in patients with menstrual disorders in tertiary care center of walled city of Delhi. J Obstet Gynaecol India 2016;66:115–9. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/27046965. https://doi.org/10.1007/s13224-014-0650-0.Search in Google Scholar

71. Szczepanek-Parulska, E, Hernik, A, Ruchała, M. Anemia in thyroid diseases. Pol Arch Intern Med 2017;127:352–60. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28400547.10.20452/pamw.3985Search in Google Scholar PubMed

72. Wopereis, DM, Du Puy, RS, van Heemst, D, Walsh, JP, Bremner, A, Bakker, SJL, et al. The relation between thyroid function and anemia: a pooled analysis of individual participant data. J Clin Endocrinol Metab 2018;103:3658–67. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/30113667. https://doi.org/10.1210/jc.2018-00481.Search in Google Scholar

73. Rhee, CM. The interaction between thyroid and kidney disease: an overview of the evidence. Curr Opin Endocrinol Diabetes Obes 2016;23:407–15. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/27428519. https://doi.org/10.1097/med.0000000000000275.Search in Google Scholar

74. Wolf, P, Beiglböck, H, Smaijs, S, Wrba, T, Rasoul-Rockenschaub, S, MarculescuR. Hypothyroidism and hyponatremia: rather coincidence than causality. Thyroid 2017;27:611–15. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28351291. https://doi.org/10.1089/thy.2016.0597.Search in Google Scholar

75. Verma, I, Sood, R, Juneja, S, Kaur, S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res 2012;2:17–9. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/23776802. https://doi.org/10.4103/2229-516x.96795.Search in Google Scholar

76. Weeks, AD. Menorrhagia and hypothyroidism. Evidence supports association between hypothyroidism and menorrhagia. BMJ 2000;320:649. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/10698899.10.1136/bmj.320.7235.649Search in Google Scholar PubMed PubMed Central

77. Chen, D, Yan, Y, Huang, H, Dong, Q, Tian, H. The association between subclinical hypothyroidism and erectile dysfunction. Pak J Med Sci 2018;34:621–5. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/30034427. https://doi.org/10.12669/pjms.343.14330.Search in Google Scholar

78. McAninch, EA, Glueck, JS, Bianco, AC. Does sex bias play a role for dissatisfied patients with hypothyroidism?. J Endocr Soc 2018;2:970–3. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/30094410. https://doi.org/10.1210/js.2018-00169.Search in Google Scholar

79. Chen, C, Xie, Z, Shen, Y, Xia, SF. The roles of thyroid and thyroid hormone in pancreas: physiology and pathology. Internet J Endocrinol 2018;2018;2861034. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/30013597.10.1155/2018/2861034Search in Google Scholar PubMed PubMed Central

80. Safer, JD. Thyroid hormone and wound healing. J Thyroid Res 2013;2013:124538. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/23577275. https://doi.org/10.1155/2013/124538.Search in Google Scholar

81. Jara, EL, Muñoz-Durango, N, Llanos, C, Fardella, C, González, PA, Bueno, SM. Modulating the function of the immune system by thyroid hormones and thyrotropin. Immunol Lett 2017;184:76–83. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28216261. https://doi.org/10.1016/j.imlet.2017.02.010.Search in Google Scholar

82. Bai, L, Zhao, J, Gao, J, Li, F, Wei, F, Li, J. Effects of Shuganjianpihuatanxingqi decoction on mild subclinical hypothyroidism: a SPIRIT compliant randomized controlled trial study protocol. Medicine (Baltim) 2018;97:e13183. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/30407354. https://doi.org/10.1097/md.0000000000013183.Search in Google Scholar

83. Braunwald, F, Kasper, H, Longo, J. Harrison’s principles of internal Medicine, 17th ed; 2008:2229–33 pp.Search in Google Scholar

84. Leng, O, Razvi, S. Hypothyroidism in the older population. Thyroid Res 2019;12:2. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/30774717.10.1186/s13044-019-0063-3Search in Google Scholar PubMed PubMed Central

85. Atalay, R, Ersoy, R, Demirezer, AB, Akın, FE, Polat, SB, Cakir, B, et al. Day-night variations in thyroid stimulating hormone and its relation with clinical status and metabolic parameters in patients with cirrhosis of the liver. Endocrine 2015;48:942–8. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/25063309. https://doi.org/10.1007/s12020-014-0364-1.Search in Google Scholar

86. Mahadevan, S, Sadacharan, D, Kannan, S, Suryanarayanan, A. Does time of sampling or food intake alter thyroid function test?. Indian J Endocrinol Metab 2017;21:369–72. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28553588. https://doi.org/10.4103/ijem.ijem_15_17.Search in Google Scholar

87. Pappa, T, Ferrara, AM, Refetoff, S. Inherited defects of thyroxine-binding proteins. Best Pract Res Clin Endocrinol Metabol 2015;29:735–47. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/26522458. https://doi.org/10.1016/j.beem.2015.09.002.Search in Google Scholar

88. Moura Neto, A, Zantut-Wittmann, DE. Abnormalities of thyroid hormone metabolism during systemic illness: the low T3 syndrome in different clinical settings. Internet J Endocrinol 2016;2016:2157583. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/27803712. https://doi.org/10.1155/2016/2157583.Search in Google Scholar

89. Pantalone, KM, Hatipoglu, B, Gupta, MK, Kennedy, L, Hamrahian, AH. Measurement of serum free thyroxine index may provide additional case detection compared to free thyroxine in the diagnosis of central hypothyroidism. Case Rep Endocrinol 2015;2015:965191. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/26779356. https://doi.org/10.1155/2015/965191.Search in Google Scholar

90. Saran, S, Gupta, BS, Philip, R, Singh, KS, Bende, SA, Agroiya, P, et al. Effect of hypothyroidism on female reproductive hormones. Indian J Endocrinol Metab 2016;20:108–13. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/26904478. https://doi.org/10.4103/2230-8210.172245.Search in Google Scholar

91. Abreu, IM, Lau, E, de Sousa Pinto, B, Carvalho, D. Subclinical hypothyroidism: to treat or not to treat, that is the question! A systematic review with meta-analysis on lipid profile. Endocr Connect 2017;6:188–99. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28249936. https://doi.org/10.1530/ec-17-0028.Search in Google Scholar

92. Hoermann, R, Midgley, JEM, Larisch, R, Dietrich, JW. Recent advances in thyroid hormone regulation: toward a new paradigm for optimal diagnosis and treatment. Front Endocrinol 2017;8:364. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/29375474. https://doi.org/10.3389/fendo.2017.00364.Search in Google Scholar

93. Clemens, K, Payne, W, Van Uum, SH. Central hypothyroidism. Can Fam Physician 2011;57:677–80. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/21673213.Search in Google Scholar

94. Persani, L, Brabant, G, Dattani, M, Bonomi, M, Feldt-Rasmussen, U, Fliers, E. European thyroid association (ETA) guidelines on the diagnosis and management of central hypothyroidism. Eur Thyroid J 2018;7:225–37. https://doi.org/10.1159/000491388.[Pubmed]. https://doi.org/10.1159/000491388.Search in Google Scholar

95. Chaudhary, V, Bano, S. Imaging of the thyroid: recent advances. Indian J Endocrinol Metab 2012;16:371–6. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/22629501. https://doi.org/10.4103/2230-8210.95674.Search in Google Scholar

96. Hong, HS, Lee, EH, Jeong, SH, Park, J, Lee, H. Ultrasonography of various thyroid diseases in children and adolescents: a pictorial essay. Korean J Radiol 2015;16:419–29. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/25741204. https://doi.org/10.3348/kjr.2015.16.2.419.Search in Google Scholar

97. Zandieh, S, Muin, D, Bernt, R, Hittmair, K, Haller, J, Hergan, K. Characteristics of incidentally found thyroid nodules in computed tomography: comparison with thyroid scintigraphy. BMC Med Imag 2017;17:8. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28109248. https://doi.org/10.1186/s12880-017-0178-8.Search in Google Scholar

98. Popoveniuc, G, Jonklaas, J. Thyroid nodules. Med Clin 2012;96:329–49. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/22443979. https://doi.org/10.1016/j.mcna.2012.02.002.Search in Google Scholar

99. Feldkamp, J, Führer, D, Luster, M, Musholt, TJ, Spitzweg, C, Schott, M. Fine needle aspiration in the investigation of thyroid nodules. Dtsch Arztebl Int 2016;113:353–9. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/27294815.10.3238/arztebl.2016.0353Search in Google Scholar

100. El Hussein, S, Omarzai, Y. Histologic findings and cytological alterations in thyroid nodules after radioactive iodine treatment for Graves’ disease: a diagnostic dilemma. Int J Surg Pathol 2017;25:314–18. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/28201927. https://doi.org/10.1177/1066896917693091.Search in Google Scholar

101. Tsegaye, B, Ergete, W. Histopathologic pattern of thyroid disease. East Afr Med J 2003;80:525–8. [Pubmed] https://www.ncbi.nlm.nih.gov/pubmed/15250625.10.4314/eamj.v80i10.8755Search in Google Scholar

102. Rafiuddin, M, Study of Qillat-e- Ifraz-e-DarqiyyaIbtidai (Primary Hypothyroidism) and therapeutic evaluation of Unani formulation in its management. Dissertation. RGUHS; 2011.Search in Google Scholar

103. Ghani, N. KhazainulAdvia. NewDelhi: Idara Kitab us Shifa 2011;1–40:179 p.[Urdu].Search in Google Scholar

104. QarabadineMajeedi. New Delhi: All India Unani Tibbi Conference; 1986:370–5 pp. [Urdu].Search in Google Scholar

105. Med, JA. Herbal approach to management of thyroid disease-a review. J Ayurveda Holist Med 2017;3:51–5.Search in Google Scholar

106. Panda, S, Kar, A. Guggulu (Commiphoramukul) potentially ameliorates hypothyroidism in female mice. Phytother Res 2005;19:78–80. https://doi.org/10.1002/ptr.1602.Search in Google Scholar

107. Jatwa, R, Kar, A. Amelioration of metformin induced hypothyroidism by WithaniasomniferaandBauhinia purpureaextracts in type 2 diabetic mice. Phytother Res 2009:1140–5. https://doi.org/10.1002/ptr.2765.Search in Google Scholar

108. Sinha, MP, Kullu, AR, Tabassum, W. Effects of leaf extracts of Moringa oleifera on regulation of hypothyroidism and lipid profile. Bioscan 2013;8:665–9. https://doi.org/10.20431/2349-0365.0406007.Search in Google Scholar

109. Panda, S, Kar, A. WithaniasomniferaandBauhinia purpureain the regulation of circulating thyroid hormone concentrations in female mice. J Ethnopharmacol 1999;67:233–9. https://doi.org/10.1016/s0378-8741(99)00018-5.Search in Google Scholar

110. Tahiliani, P, Kar, A. Role of Moringa oleifera leaf extract in the regulation of thyroid hormone status in adult male and female rats. Pharmacol Res 2000;41:319–23. https://doi.org/10.1006/phrs.1999.0587.Search in Google Scholar

111. Kar, A, Panda, S, Bharti, S. Relative efficacy of three medicinal plant extracts in the alteration of thyroid hormone concentrations in male mice. J Ethnopharmacol 2002;81:281–5. https://doi.org/10.1016/s0378-8741(02)00048-x.Search in Google Scholar

112. Kanzaria, H, Dave, AR, Manani, Y, Agravat, P. A clinical study on hypothyroidism and its management withvidanga. Eur J Biomed Pharmaceut Sci 2017;4:241–4.Search in Google Scholar

113. Ashwini, S, Bobby, Z, Sridhar, MG, Cleetus, CC. Insulin plant (Costuspictus) extract restores thyroid hormone levels in experimental hypothyroidism. Pharmacogn Res 2017;9:51–9. https://doi.org/10.4103/0974-8490.199766.Search in Google Scholar

Received: 2020-04-26
Accepted: 2020-05-22
Published Online: 2020-08-10

© 2020 Walter de Gruyter GmbH, Berlin/Boston

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