Professional Documents
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Vinudha
Vinudha
By
Dr. S.VINUDHA,B.N.Y.S
Reg.461612005
DOCTOR OF MEDICINE
IN
YOGA
Dr. S. T. VENKATESWARAN
Date: ND(OSM),MSC(Y&N),PGDY,PGDM,DNHE,
Place: Prof. & HoD
PG. Dept. of Yoga
GYNMC & H, Arumbakkam, Chennai
i
TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY,
Department of Yoga, Govt. Yoga & Naturopathy Medical College & Hospital,
Arumbakkam, Chennai.
Dr. S. T. VENKATESWARAN
Date: ND(OSM),MSC(Y&N),PGDY,PGDM,DNHE,
Place: Prof. & HoD
PG. Dept. of Yoga
GYNMC & H, Arumbakkam, Chennai
ii
TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY,
Department of Yoga, Govt. Yoga & Naturopathy Medical College & Hospital,
Arumbakkam, Chennai.
iii
THE TAMILNADU Dr. M. G. R. MEDICAL UNIVERSITY,
Yoga, Govt. Yoga & Naturopathy Medical College & Hospital, Arumbakkam, Chennai.
Dr. S.VINUDHA
Date:
Place: Post Graduate in Yoga
GYNMC & H, Arumbakkam, Chennai
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INSTITUTIONAL ETHICS COMMITTEE
GOVERNMENT YOGA AND NATUROPATHY MEDICAL COLLEGE AND
HOSPITAL, CHENNAI – 600 106
CERTIFICATE OF APPROVAL
College,reviewed and discussed the application for approval of the proposal “EFFICACY
v
COPYRIGHT
I hereby declare that the Tamil Nadu Dr. M. G. R. Medical University, Chennai, Tamil
Nadu shall have the rights to preserve, use and disseminate this Dissertation/Thesis in
vi
ACKNOWLEGDEMENT
Foremost, I express my sincere gratitude to Dr. Manavalan, Principal, Govt. Yoga and
my Post Graduation degree from this prestigious institute. I also extend my gratitude
GYNMC, Arumbakkam, Chennai-106, for his constant support and encouragement. I also
thank Late Dr. R. S. Himeshwari H.O.D. Acupuncture and Energy Medicine for her
manuscript preparation, Dr. R. Jain Raj, AMO for helping me throughout the statistical
analysis and its interpretations and Dr. P. Kumaresan, AMO for providing me valuable
suggestions needed for this study. I also thank all the teaching and non-teaching staff of this
I would like to dedicate this dissertation, and the ability to persevere and finish, to my Lord.
Without His help, I would not have completed this task. To my husband, Mr. M.
Ravikumar, who came into my messy office at just the right moments to make me smile
and encourage me…thank you. To my son R. Vignesh, who have been with me through
this process. I also thank my parents Mr. Subramanian and Mrs. Vandarkuzhali
Subramanian and my brother S. Venkatesh for the encouragement, prayers, and moral
support along the way. I also acknowledge the support of all the subjects who participated
in the study.
vii
LIST OF ABBREVIATIONS
T3 Tri-iodothyroxine
T4 Thyroxine
CG Control Group
SG Study Group
MIT Monoiodotyrosin
DIT Diiodotyrosine
viii
ABSTRACT
Objective: The intended research work aims to evaluate the effect of 12 week Ujjayi
pranayama on Hypothyroidism in adults and to compare the changes in BMI and Thyroid
before and after Psychic breathing technique .Many studies reported that the practice of
yoga, especially pranayama‘ influences BMI. The current study was conducted to
Study Design: The current research work employed A Randomized Controlled Trail.
Method:
Potential subject will be screened and eligible patients will be recruited for the study.A
group belonging within the age group of 18-55 participate in the study. After obtaining
informed consent both the group will be subjected to general measures like BMI, Thyroid
Function Test before and after the study. The study Group will be subjected to Ujjayi
Pranayama for 15 minutes twice a day for 6 days a week for 12 weeks.
Result:
Results of the pre and post measurements on T3, T4, TSH, Body weight and BMI among
Ujjai pranayama along with standard drug group for a period of 90 days shows that Body
weight was reduced and T3 got raised statistically significant after the yoga intervention
ix
where as T4 doesn’t show’s any statistical significance after the yoga intervention. Even
though in yoga intervention group T4 doesn’t show statistical significance its mean value
raised to a marked level from 8.05 to 8.54 mg/dl .This shows that ujjai pranayama is
influencing the T4 secretion. TSH level reduced significantly after the practice of ujjai
Conclusion:
This study showed that 90 days of Ujjayi Pranayama reduced Body mass index and
differences in Thyroxine (T4) hypothyroid patients. This revealed that yoga practice has
significant role in improvement in the weight reduction. Further research need in this
field with a larger sample size and duration is warranted to reveal accurate changes in this
field.
Keywords:
Hormone,
x
Table of contents
1 INTRODUCTION 1
3 REVIEW OF LITERATURE 8
5 RESULTS 56
6 DISCUSSION 62
7 CONCLUSION 63
8 SUMMARY 64
9 REFERENCES 66
10 ANNEXURE 76
xi
LIST OF TABLES
groups
xii
LIST OF FIGURES
xiii
1.0 INTRODUCTION
thyroid hormone from thyroid gland due to some of the structural or functional
impairment of the thyroid hormone production(1). The thyroid gland is located inside the
neck, just below adam’s apple and It produces two thyroid hormones, triodothyronine
(T3) and thyroxine (T4), which regulate the body metabolic rate(2). Hypothyroidism
affects all the organ systems and main clinical findings are fatigue, weakness, dryness,
serous cavitary effusion(3).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(4). It is classified as secondary when TSH is low and
T4 and T3 levels are high and presents a large epidemiological burden in India(5).
disorders can range from a small, harmless goiter (enlarged gland) that needs no
treatment to life threatening cancer(7). The most common thyroid problems involve
abnormal production leads to hypothyroidism, as the result of subtle and non specific
clinical symptoms and signs, the condition often go undiagnosed and are not adequately
hormones with age and illness, it is important to tailor the diagnosis and management of
1
this condition in specific populations including pregnant women, infants, children,
1.1 YOGA
Yoga is an art and scince of healthy living. The word ‘Yoga’ is derived from the Sanskrit
root ‘Yuj’, meaning ‘to join’ or ‘to yoke’ or ‘to unite’. As per Yogic scriptures the
practice of Yoga leads to the union of individual consciousness with that of the Universal
Consciousness, indicating a perfect harmony between the mind and body, Man &
leading to 'the state of liberation' (Moksha) or ‘freedom’ (Kaivalya). Living with freedom
in all walks of life, health and harmony shall be the main objectives of Yoga practice.
"Yoga” also refers to an inner science comprising of a variety of methods through which
human beings can realize this union and achieve mastery over their destiny (12). Yoga,
civilization dating back to 2700 B.C., has proved itself catering to both material and
spiritual upliftment of humanity. Basic humane values are the very identity of Yoga
Sadhana. Yoga is also commonly understood as a therapy or exercise system for health
and fitness. While physical and mental health is natural consequences of yoga, the goal of
yoga is more far-reaching (13). "Yoga is about harmonizing oneself with the universe. It
is the technology of aligning individual geometry with the cosmic, to achieve the highest
The great sage Patanjali, in the system of Raja Yoga, gave one of the best definitions of
yoga. He said, ‘Yoga is the blocking (nirodha) of mental modifications (chitta vritti) so
that the seer (drashta) re-identifies with the (higher) Self. Patanjali’s system has come to
2
be the epitome of Classical Yoga Philosophy and is one of the 7 major philosophies of
India(14). Patanjali gives a wide range of techniques that slowly harmonizes the mind
and gradually induces more subtle perception. However, the main path of Patanjali is
These first five stages are the esoteric/bahiranga (external) practices of yoga. They
Dharana (concentration)
Dhyana (meditation)
Samadhi (superconsciousness)
These last three stages are the esoteric or antaranga (internal) practices of yoga. The first
five stages negate consciousness, whilst the last three stages expand consciousness.
1.2 PRANAYAMA
Practicing Pranayama helps in controlling the breath. The terminology was coined from
the two root words namely ‘prana’ meaning ‗vital energy‘ and ayama’ meaning
breathing exercise; rather it aims at channeling the flow of excess oxygen into the lungs,
3
thereby, transporting it to all the systemic organs of the body(15).In the pranayama
practices there are four important aspects of breathing which are utilized. These are:
Pooraka or inhalation
Rechaka or exhalation
As Yoga was globally regarded as The ancient Indian science‘ which comprised of
different autonomic and cardiac responses among healthy humans(16). Many reports
claimed that the practice of pranayama aids in eliminating the toxins away from the body
and helps in maintaining a good health. There are different variations/types of pranayama
such as
AnulomVilom Pranayama
Bahya Pranayama
Bhastrika Pranayama
Bhramari Pranayama
Digra Pranayama
Kapalbhati Pranayama
NadiSodhana Pranayama
Shitali Pranayama
Udgit Pranayama
Ujjayi Pranayama
4
1.3 GHERANDA SAMHITA
Gheranda Samhita is a Sanskrit text of Yoga in Hinduism and it is one of the three
classic texts of hatha yoga . The Gheranda Samhita calls itself a book on ghatastha yoga,
which literally means "vessel yoga", wherein the body and mind are depicted as vessels
that carry and serve the soul (atman, purusha). The text teaches a seven limbed. Gheranda
Samhita is a step by step detailed manual of yoga taught by sage Gheranda to student
Chanda.[14] Unlike other hatha yoga texts, the Gheranda Samhita speaks of a sevenfold
Yoga and Pranayama is one of the important practice explained in this text
Ujjayi Prananaya or the psychic breath soothes the mind and induces a meditative
state. Ujjayi means to ‘lift up’. In Ujjayi pranayama, the chest is slightly lifted up as if
the inhalation is done from the throat. Ujjayipranayama is mentioned in the yoga
text Hatha Yoga Pradeepika and in the Gheranda Samhita. The Procedure of Ujjayi
Contract the glottis, so that the passage of the throat is partially closed
Roll the tongue up and let the lower side of the tongue touch the upper palate
Breath in slowly through the throat, amking a slight hissing snoring sound.
When the inhalation is complete, swallow the breath and perform Jalandhara
Retain the breath inside for asa long as you are comfortable
Reseale the chin lock (Jalandhara Bandha) and exhale through both the nostrils.
5
The current study focuses on Ujjayi pranayama on adult hypothyroidism and its impact
on BMI and Thyroid Function Test. Thus Ujjaiyi is considered as supportive and
hypothyroid disorder. Though Ujjayi pranayama is being widely used as a yoga therapy
for various diseases in Yogic system of medicine, to the best of our knowledge, there is
Hypothyroidism. Hence the rationale is to observe the changes in BMI and Thyroid
6
2.0 AIMS AND OBJECTIVES
2.1 AIM
The aim of this study was to asses the effect of Ujjayi pranayama on adult
Hypothyroidism
Arumbakkam, Chennai.
2.2.2 Secondary Objective: To compare the changes in BMI and Thyroid Function
7
3.0 REVIEW OF LITERATURE
3.1 HYPOTHYROIDISM
thyroid hormone from thyroid gland due to some of the structural or functional
impairment of the thyroid hormone production(14). The thyroid gland is located inside
the neck, just below adam’s apple. It produces two thyroid hormones, triiodothyronine
(T3) and thyroxine (T4), which regulate the body metabolic rate(17).
There are intricate feedback mechanisms between the thyroid and anterior pituitary,
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(18).
8
3.2 PREVALENCE OF HYPOTHYROIDISM
hypothyroidism is reported in India is around 10.95% . One in ten adults is said to have
hypothyroidism in India(19). In fact an estimated 108 million people in India suffer from
endocrine and metabolic disorders. Several of these diseases are caused by environmental
factors .therefore , their prevalence is several fold higher. Thyroid disorders are the most
production of thyroid stimulating hormone (TSH) ,or hypothalamus, which regulates the
pituitary gland via thyrotropin releasing hormone(TRH). Thyroid disorders can range
from a small, harmless goiter (enlarged gland) that needs no treatment to life threatening
cancer. The most common thyroid problems involve abnormal production leads to
9
hypothyroidism(21). As a result of subtle and non specific clinical symptoms and signs,
the condition often go undiagnosed and are not adequately treated when it is detected.
a result of the physiological changes in thyroid hormones with age and illness, it is
important to tailor the diagnosis and management of this condition in specific populations
including women, infants, children, geriatric patients, and those with comorbid
conditions(22).
Thyroid gland is an endocrine gland in the neck, consisting of two lobes connected by
an isthmus and is found at the front of the neck, below the Adam's apple. The thyroid
hormones primarily influence the metabolic rate and protein synthesis. Calcitonin plays
an important role in calcium homeostasis. Hormonal output from the thyroid is regulated
by thyroid-stimulating hormone (TSH) secreted from the anterior pituitary gland, which
the hypothalamus(24).
10
Figure 3: Flow chart of HPT axis
hormone production. the most common cause is iodine deficiency. Thyroid hormones are
autoimmune disorder. In addition, the thyroid gland may also develop several types
11
3.3.1 BLOOD SUPPLY OF THYROID GLAND
The thyroid is supplied with arterial blood from the superior thyroid artery, a branch of
the external carotid artery, and the inferior thyroid artery, a branch of the thyro cervical
trunk, and sometimes by an anatomical variant the thyroid in an artery, which has a
variable origin(26). The superior thyroid artery splits into anterior and posterior branches
supplying the thyroid, and the inferior thyroid artery splits into superior and inferior
branches(27). The superior and inferior thyroid arteries join together behind the outer part
of the thyroid lobes(28). The venous blood is drained via superior and middle thyroid
veins, which drain to the internal jugular vein, and via the inferior thyroid veins(29). The
inferior thyroid veins originate in a network of veins and drain into the left and
right brachiocephalic veins(30). Both arteries and veins form a plexus between the two
Lymphatic drainage frequently passes the pre laryngeal lymph nodes (located just above
the isthmus), and the pre tracheal and para tracheal lymph nodes(31).
The gland receives sympathetic nerve supply from the superior, middle and inferior
nerve supply from the superior laryngeal nerve and the recurrent laryngeal nerve(32).
3.3.4 VARIATION:
Sometimes there is a third lobe present called the pyramidal lobe. This lobe often
stretches up the hyoid bone from the thyroid isthmus and may be one to several divided
12
lobes and it present in 18.3% to 44.6%. It mainly arises from the left side and
small horn at the back of the thyroid lobes, usually close to the recurrent laryngeal nerve
and the inferior thyroid artery, is called Zuckerkandl's tubercle(34). Other variants
include a levator muscle of thyroid gland, connecting the isthmus to the body of the hyoid
3.3.5 MICROANATOMY
1. Follicles
2. Follicular cells
FOLLICLES
Thyroid follicles are small spherical groupings of cells 0.02–0.9mm in diameter that play
the main role in thyroid function(36). They consist of a rim that has a rich blood supply,
13
nerve and lymphatic presence, that surrounds a core of colloid that consists mostly of
FOLLICULAR CELLS
The core of a follicle is surrounded by a single layer of follicular cells. When stimulated
by thyroid stimulating hormone (TSH), these secrete the thyroid hormones T3 and T4.
colloid(37). Follicular cells vary in shape from flat to cuboid to columnar, depending on
Scattered among follicular cells and in spaces between the spherical follicles are another
type of thyroid cell, parafollicular cells secrete calcitonin and so are also called C
cells(4).
The primary function of the thyroid is the production of iodine containing thyroid
hormones such as
Thyroxine (T4)
The thyroid hormones are created from iodine and tyrosine. T3 is so named because it
contains three atoms of iodine per molecule and T4 contains four atoms of iodine per
molecule. The thyroid hormones have a wide range of effects on the human body.
14
Figure 5 : Hypothalamic pituitary thyroid axis
METABOLISM
The thyroid hormones increase the basal metabolic rate and have effects on almost all
body tissues. Appetite, the absorption of substances, and gut motility are all influenced by
thyroid hormones(38). They increase the absorption in the gut, generation, uptake by
cells, and breakdown of glucose. They stimulate the breakdown of fats, and increase the
number of free fatty acids. Despite increasing free fatty acids, thyroid hormones
15
Figure 6 : Feedback mechanism of thyroid system
CARDIOVASCULAR:
Thyroid hormones increase the rate and strength of the heartbeat. They increase the rate
of mitochondria(39). Combined, these factors increase blood flow and the body's
temperature.
DEVELOPMENT:
Thyroid hormones are important for normal development. They increase the growth rate
of young people, and cells of the developing brain .Thyroid hormones play a particularly
16
crucial role in brain maturation during fetal development and first few years of postnatal
life(1).
SEXUAL FUNCTION:
Thyroid hormones also play a role in maintaining normal sexual function, sleep, and
thought patterns. Increased levels are associated with increased speed of thought
generation but decreased focus. Sexual function, including libido and the maintenance of
a normal menstrual cycle, are influenced by thyroid hormones(28). After secretion, only a
very small proportion of the thyroid hormones travel freely in the blood. Most are bound
to thyroxine binding globulin (about70%), transthyretin (10%), and albumin (15%). Only
the 0.03% of T4 and 0.3% of T3 traveling freely have hormonal activity(40). In addition,
deiodinases in organs around the body. Thyroid hormones act by crossing the cell
α2,TR-β1 and TR-β2, which ind with hormone response elements and transcription
factors to modulate DNA transcription.In addition to these actions on DNA, the thyroid
hormones also act within the cell membrane or within cytoplasm via reactions
with enzymes, including calcium ATPase, adenylyl cyclase, and glucose transporters(24).
Iodine is essential for the production of the thyroid hormones. Iodine (I0) travels in the
blood as iodide (I−), which is taken up into the follicular cells by a sodium-iodide
symporter. This is an ion channel on the cell membrane which in the same action
transports two sodium ions and an iodide ion into the cell(14). Iodide then travels from
within the cell into the follicular space, through the action of pendrin, an iodide-
chloride antiporter. In the follicular space, the iodide is then oxidized to iodine. This
17
makes it more reactive, and the iodine is attached to the active tyrosine units in
When the follicular cells are stimulated by thyroid-stimulating hormone, the follicular
cells reabsorb thyroglobulin from the follicular space. The iodinated tyrosines are
cleaved, forming the thyroid hormones T4, T3, DIT, MIT, and traces of reverse
triiodothyronine(14). T3and T4 are released into the blood. The hormones secreted from
the gland are about 80–90% T4 and about 10–20% T3. Deiodinase enzymes in peripheral
tissues remove the iodine from MIT and DIT and convert T4 to T3 and RT3. This is a
major source of both RT3 (95%) and T3 (87%) in peripheral tissues.The signs and
Problems tend to develop slowly, often over a number of years. At first, you may barely
notice the symptoms of hypothyroidism, such as fatigue and weight gain. Or you may
18
simply attribute them to getting older(42). But as your metabolism continues to slow, you
3.3.8 ETIOLOGY
Hypothyroidism results when the thyroid gland fails to produce enough hormones., the
balance of chemical reactions in the body can be upset and have an enormous impact on
health, affecting all aspects of metabolism. These hormones also influence the control of
vital functions, such as body temperature and heart rate(44). There can be a number of
AUTOIMMUNE DISEASE:
produces antibodies that attack its own tissues. Sometimes this process involves your
thyroid gland.
People who produce too much thyroid hormone (hyperthyroidism) are often treated with
thyroid function back to normal. But sometimes, correcting hyperthyroidism can end up
THYROID SURGERY:
19
Removing all or a large portion of your thyroid gland can diminish or halt hormone
production. In that case, you'll need to take thyroid hormone for life.
RADIO THERAPY:
Radiation used to treat cancers of the head and neck can affect your thyroid gland and
MEDICATION:
lithium, which is used to treat certain psychiatric disorders. If you're taking medication,
CONGENITAL DISEASE:
Some babies are born with a defective thyroid gland or no thyroid gland. In most cases,
the thyroid gland didn't develop normally for unknown reasons, but some children have
an inherited form of the disorder. Often, infants with congenital hypothyroidism appear
normal at birth. That's one reason why most states now require new-born thyroid
screening.
PITUITARY DISORDER:
A relatively rare cause of hypothyroidism is the failure of the pituitary gland to produce
pituitary gland.
PREGNANCY:
hypothyroidism), often because they produce antibodies to their own thyroid gland. Left
20
untreated, hypothyroidism increases the risk of miscarriage, premature delivery and
during the last three months of pregnancy. It can also seriously affect the developing
fetus.
IODINE DEFICIENCY:
The trace mineral iodine is mainly found primarily in seafood, seaweed, plants grown in
iodine-rich soil and iodized salt which is essential for the production of thyroid
hormones. Too little iodine can lead to hypothyroidism, and too much iodine can worsen
hypothyroidism in people who already have the condition. In some parts of the world,
iodine deficiency is common, but the addition of iodine to table salt has virtually
Complications
Goiter. Constant stimulation of your thyroid to release more hormones may cause
the gland to become larger — a condition known as a goiter. Although generally not
uncomfortable, a large goiter can affect your appearance and may interfere with
swallowing or breathing.
of heart disease and heart failure, primarily because high levels of low-density
lipoprotein (LDL) cholesterol the "bad" cholesterol that can occur in people with an
underactive thyroid.
21
Mental health issues. Depression may occur early in hypothyroidism and may
become more severe over time. Hypothyroidism can also cause slowed mental
functioning.
damage to your peripheral nerves. These are the nerves that carry information from
your brain and spinal cord to the rest of your body. for example, your arms and legs.
Peripheral neuropathy may cause pain, numbness and tingling in affected areas.
undiagnosed hypothyroidism. Its signs and symptoms include intense cold intolerance
coma may be triggered by sedatives, infection or other stress on your body. If you
treatment.
Infertility. Low levels of thyroid hormone can interfere with ovulation, which
Birth defects. Babies born to women with untreated thyroid disease may have a
higher risk of birth defects compared to babies born to healthy mothers. These
children are also more prone to serious intellectual and developmental problems.
Infants with untreated hypothyroidism present at birth are at risk of serious problems
with both physical and mental development(45). But if this condition is diagnosed
within the first few months of life, the chances of normal development are excellent.
Constipation
Dry skin
Weight gain
Puffy face
Hoarseness
Muscle weakness
Thinning hair
Depression
Impaired memory
23
Figure 9: Symptoms of hypothyroidism
The thyroid is a butterfly-shaped gland located in the front of the neck just above the
produces and releases into the circulation at least two potent hormones, thyroxine (T4)
and triiodothyronine (T3), which influence basal metabolic processes and/or enhance
oxygen consumption in nearly all body tissues(20). Thyroid hormones also influence
24
linear growth, brain function including intelligence and memory, neural development,
dentition, and bone development(1).The thyroid gland produces T4 and T3 utilizing iodide
obtained either from dietary sources or from the metabolism of thyroid hormones and
United States ranges between 200 and 500 µg/day and varies geographically; ingestion is
higher in the western part of the United States than in the eastern states. The specialized
thyroid epithelial cells of the thyroid gland are equipped with a Na/I symporter that helps
concentrate iodide 30 to 40 times the level in plasma to ensure adequate amounts for the
synthesis of thyroid hormone. The iodide trapped by the thyroid gland is subsequently
oxidized to iodine by the enzyme thyroid peroxidase(38). The iodine then undergoes a
thyroxine (T4) and triiodothyronine (T3)(46). T3 is also produced in other tissues such as
the pituitary, liver, and kidney by the removal of an iodine molecule from T4. T4 is
produced. T4 and T3 are both stored in the thyroglobulin protein of the thyroid gland and
released into the circulation through the action of pituitary derived thyrotropin (thyroid
stimulating hormone or TSH)(47). A normal individual produces from the thyroid gland
percent of the T3 produced daily in humans is derived from peripheral metabolism (5′-
monodeiodination) of T4, with only about 20 percent secreted directly from the thyroid
gland itself. On a weight basis, T3 is about 3 to 5 times more potent as a thyroid hormone
than T4 and is believed to be the biologically active form of the hormone(48). TSH,
secreted by thyrotroph cells located in the anterior pituitary gland, regulates thyroid gland
releasing hormone (TRH) produced in the hypothalamus . The secretion of both TSH and
TRH is regulated by negative feedback from thyroid hormone, predominantly T3, from
the circulation and/or T3 that is produced locally from intracellular conversion of T4 to T3.
When circulating thyroid hormone levels are elevated, both the synthesis and secretion of
serum TSH are blunted(49). In contrast, when circulating levels of T4 and T3 are low,
serum TSH levels are increased in a compensatory fashion. The geometric mean level of
serum TSH in normal individuals is approximately 1.5 µU/ml as recently reported in the
NHANES III study(50). When hypothalamic pituitary function is intact, serum TSH
levels are markedly suppressed (to <0.05 µU/ml) in patients with hyperthyroidism and
elevated circulatory levels of serum thyroxine, while a marked increase in TSH (>5
µU/ml) occurs in patients with hypothyroidism and low blood levels of serum T4. The
mechanism through which TSH binds to and activates the thyroid gland is well
understood. TSH binds to a specific membrane receptor located on the surface of the
thyroid epithelial cell and activates the cell signaling mechanisms through the enzyme
stimulate additional intracellular signaling events that lead to thyroid hormone formation
and secretion.T4 and T3 circulate bound primarily to carrier proteins. T4 binds strongly to
tightly to TBG and weakly to albumin, with little binding to TBPA. The geometric mean
for serum T4 in normal individuals is approximately 8 µg/dl, while the mean serum
T3 level is approximately 130 ng/dl. Under normal protein binding conditions, all but
0.03 percent of serum T4 and 0.3 percent of serum T3 is protein bound. Only a small
26
amount of unbound (or free) T4 (approximately 2 ng/dl) and T3 (approximately 0.3 ng/dl)
circulates in a free state, and it is this free concentration that is considered responsible for
There are physiologic situations associated with a change in the serum concentration of
drugs—that affect the level and/or affinity of these binding proteins(53). Under these
circumstances, the serum concentrations of total T4 and total T3 change in parallel to the
changes that occur in the thyroid hormone binding proteins, but the serum concentrations
of free T4 and free T3 remain normal and the individual remains euthyroid(54). In
contrast, the serum concentration of free T4 and free T3 are raised in hyperthyroidism and
decreased in hypothyroidism.
The most sensitive test in an ambulatory population at risk for thyroid dysfunction is the
serum TSH. Serum TSH assays today have sufficient sensitivity and specificity to
identify individuals with all forms of thyroid dysfunction in the general population(55).
However, among individuals with serious, acute illness, the serum TSH is less specific
for thyroid disease because a serious illness alone can depress TSH. TSH screening of the
mandated throughout the United States and in many other countries. Serum TSH
measurements may yield misleading results for individuals with changing levels of
thyroid hormones. For example, a serum TSH level may remain high for weeks in
hypothyroid patients treated with T4. Similarly, serum TSH levels may remain low for
weeks after the serum T4 level falls to normal in patients treated for hyperthyroidism.
27
Diagnosis of Hypothyroidism:
Hypothyroidism is a hypometabolic state that results from a deficiency in T4 and T3. Its
major clinical manifestations are fatigue, lethargy, cold intolerance, slowed speech and
intellectual function, slowed reflexes, hair loss, dry skin, weight gain, and constipation. It
is more prevalent in women than men. The most common cause of hypothyroidism is
disease of the thyroid itself, primary hypothyroidism. The most common cause of
which the thyroid is destroyed by antibodies or lymphocytes that attack the gland. Other
causes are radioactive iodine and surgical therapy for hyperthyroidism or thyroid cancer,
thyroid inflammatory disease, iodine deficiency, and several drugs that interfere with the
synthesis or availability of thyroid hormone. Hypothyroidism may also occur rarely (<1
T3 levels and TSH secretion. People with primary hypothyroidism have high serum TSH
levels. If an individual has a high serum TSH value, serum free T4 should be measured.
The concomitant finding of a high serum TSH concentration and a low free T4 level
confirms the diagnosis of primary hypothyroidism. People with a high serum TSH
findings of a low serum free T4 level and a serum TSH level that is normal or low. People
on measurements of serum TSH, but the condition is much less common than primary
hypothyroidism.
28
3.3.12 CONVENTIONAL TREATMENT FOR HYPOTHYROIDISM
Historical perspective
By the end of the 19th century, myxedema had been attributed to diminished thyroid
function and a cretinism-like condition (also described as cachexia strumipriva) had been
women suffering from myxedema temporarily. In 1891, Murray described the first
thyroid into a patient with hypothyroidism(2). It was soon shown that oral administration
of thyroid extract was as effective. In 1914, Kendall purified thyroxine crystals, which
1926 and synthetic thyroxine was available for clinical use by the 1930s. However, it
took many more years before thyroxine became preferable to desiccated thyroid extract
Dosage of levothyroxine
allowing daily dosing. A randomized controlled trial has shown that, in patients with no
(1.6 μg/kg/day) is safe, effective, and requires fewer resources than using a more
traditional approach of starting with a small dose and gradually titrating upward(36). The
29
exceptions to this are the elderly and patients with known ischemic heart disease (see the
Timing of levothyroxine
stable dose of morning levothyroxine found a decrease in mean TSH and an increase in
free thyroid hormone levels when the timing of levothyroxine dosage was changed to
trial of 105 consecutive patients, have reaffirmed that biochemical control was best
mean TSH of 1.25 mIU/L (95% confidence interval [CI] 0.60–1.89), and an increase in
free T4 of 0.07 ng/dL (95% CI 0.02–0.13) and total T3 of 6.5 ng/dL (95% CI 0.9–
no significant decrease in mean TSH of 0.29 mIU/L when the time of administration of
randomized crossover trial in the US compared taking levothyroxine in the fasting state,
cancer, and found that TSH levels were significantly lower and less variable when
levothyroxine was taken in the fasting state than at other times(60). Furthermore, Rajput
their levothyroxine half an hour before breakfast or two hours after their evening meal,
30
and found no difference in TSH, lipid profile, clinical symptoms, quality of life scores, or
the dose required to achieve euthyroidism between the two groups(61). The conflicting
studied (for example, newly diagnosed patients versus patients on a stable dose of
levothyroxine, and patients with thyroid cancer versus patients with autoimmune
could be tried as an alternative strategy in those patients who have problems in taking
When initiating levothyroxine therapy, serum TSH should be measured to monitor for
adequate replacement. TSH can take up to 4 months to normalize, even when starting on
that the TSH is measured 6–8 weeks after initiation of, or a change in levothyroxine dose.
recommended, although a retrospective study suggests that the monitoring interval could
31
Taking levothyroxine with food
Malabsorption
It is generally recommended to aim for a TSH in the lower half of the normal range, ie,
titrating the dose of levothyroxine until the TSH was at the lower end of reference range
or suppressed below the reference range was found to be associated with improved
double-blind randomized crossover trial, which has shown that small changes in
levothyroxine dose to achieve a lower TSH do not result in an improved quality of life
maintained on low TSH (0.4–2.0 mIU/L) as compared with those maintained on higher
TSH (2–4 mIU/L) for 12 months, although resting energy expenditure was higher in
levothyroxine leading to a suppressed TSH of below 0.1 mIU/L has been shown to be
associated with adverse skeletal health, particularly in the elderly . Taken together, these
observations suggest that the target TSH level for most nonpregnant patients with
32
reference range and one should not necessarily increase the dose of levothyroxine in
asymptomatic people with a TSH in the upper half of the normal range.
Several medications, supplements, and food can interfere with the absorption and action
of levothyroxine .Common drugs that can affect levothyroxine absorption include iron,
calcium, cholestyramine, and aluminum and levothyroxine must be taken at least 4 hours
altered metabolism of medications, such that when rendered euthyroid, patients with
hypothyroidism may need alterations in the dose of their medications. For example,
Drugs and supplement that decrease the effect of Levothyroxine are Iron, Calcium
33
3.3.13 COMPLEMENTARY TREATMENT FOR HYPOTHYROIDISM:
The National Institutes of Health National Center for Complementary and Alternative
Medicine (NIH NCCAM) defines complementary medicine as being used along with
standard medical treatments, and alternative medicine as being used in place of standard
includes a patients’ mind body and spirit; this combines standard medicine with CAM
practices
The NIH NCCAM uses five categories to describe the different types of CAM. It would
be difficult to create a comprehensive list, but some examples are described below:
MIND-BODY MEDICINES
These are based on a belief that the mind is able to affect your body. Examples include:
Yoga
Meditation
Hypnosis
BIOLOGICALLY-BASED PRACTICES
These include things most often found in nature, and includes dietary supplements and
Vitamins
Herbs
Special diets
The patients with Hypothyroidism are recommended to practice a special diet that avoids
foods that contain iodine. In fact, use of iodine either in liquid form or as a supplement is
34
not recommended. It’s also common for patients to be told to take Vitamin D or calcium
supplementation.
These are based on working with the body and are thought to have underlying benefits
Massage
Chiropraxy
ENERGY MEDICINE
Energy medicine invokes the belief that the body has energy fields that can be
Reiki
Tai Chi
These systems include beliefs and approaches to healing and wellness that come from all
Naturopathy
Homeopathy
Chinese medicine
Vodun/Expiritism
Ayurvedic medicine
Yogic disciplines involving Pranayama claimed to have very good effect on Thyroid
function , thus creating psychic and somatic equilibrium of the bodily functions.
35
Pranayama in actuality is regarded as the science of controlled as well as conscious
expansion of the prana representing the life force. The practice of pranayama helps in
facilitating the therapeutic potential for several systemic complications. The study
specific clinical symptoms and signs, the condition often goes undiagnosed and is not
thyroid hormones with age and illness, it is important to tailor the diagnosis and
children, geriatric patients, and those with comorbid conditions. Enhanced understanding
and education of physicians and patients can help to improve the outcomes of treatment
reforms should be crafted and implemented at the national level to curb public health
national advisory board meeting to identify and bridge the gaps in understanding of the
hypothyroidism in the community and clinics for the benefit of the patients. In the study
hormone or, more rarely, from their impaired activity at tissue level.
36
Hypothyroidism is characterized by a broad clinical spectrum ranging from an overt state
subclinical condition with normal levels of thyroxine and triiodothyronine and mildly
developed world is about 4-5%. In a developing and densely populated country like
India, communicable diseases are priority health concerns due to their large contribution
The study on The Thyroid registry states that Patients with SCH have a high rate of
progression to overt hypothyroidism(61). However, the true prevalence of SCH could not
patients (n = 1208); this could be higher in our population. In the study, TSH and T4
levels were available for only 291 patients at baseline. This highlights the fact that
common clinical practice is focused only on screening patients for TSH levels and does
not include T4 estimation. In addition, for patients with TSH level at borderline or <10
mIU/L, it is recommended that the decision to treat should be based on T4 levels. The
thyroid hormone profile, levothyroxine dose, and resolution of symptoms, if any, were
being recorded for subsequent follow-up visits. However, this study brings out an
warranting the need for educating our medical fraternity. Appropriate assessment with
both T4 and TSH levels and when required, assessment of T3 level and thyroid
peroxidase antibodies are essential and should be practiced in routine clinical setup.
most of the patients from this registry study were advised treatment with levothyroxine
based on TSH levels alone, thus highlighting the need for awareness and scientific
mcg) of levothyroxine may point toward empirical management practices. However, this
In the study it is observed that a significant reduction in total cholesterol (8.99%), LDL
(9.65%)(60). The mean thyroxine medication score was medication was observed in any
of the subjects at the end of the study. Previously, two studies have looked into the
yoga practice showed significant improvement in the quality of life(64), and in another
volume in lung function test of women with hypothyroidism (63). These studies are
studies, 12 weeks of yoga intervention in elderly women with diabetes showed significant
randomized control trial, 6 months of yoga nidra (yogic relaxation method) practice was
shown to reduce the serum TSH level in females with menstrual abnormalities(10). In our
study also we found similar results as that of the previous one. The exact mechanism
behind these finding is not known. One of the possible mechanisms could be increased
physical activity due to Suryanamaskar and physical postures might have helped in
reducing triglycerides, total cholesterol, LDL and increased HDL cholesterol(29). The
pranayama, relaxation practices and meditation are known to reduce stress and modulate
hypothalamo-pituitary–thyroid axis and lead to decrease in serum TSH. This study shows
controlled design with a larger sample size and other objective variables like
term practice of yoga may help in improving cholesterol level, serum TSH and thyroxine
randomized controlled studies need to be conducted. The effect of yogic practices was
significant for hypothyroid patients in improving their quality of life. Prior to the therapy,
scores on the physical health domains were low,the improved significant after therapy
indicate that the physical health of hypothyroid patients had been improved. Patients
reported that theywere more finding the activities of daily living easier, they were more
energetic, mobile and their work capacity had increased. They also reported less pain and
discomfort. The results also indicated a positive effect from yoga practice on
psychological health. Following therapy patients scores had markedly improved from pre
therapy scores with a post therapy scores. Subject reported feeling more positive and
expressed higher perceptions of self esteem,nothing that they were happy with their body
scores, The quality of life scores on social relationship domin before yoga therapy
compared to post therapy rating.The practice of yoga generally leads to a more efficient
functioning of the psycho- neuro- endocrine and immune system. This is affected by
increased physical flexibility and greater awareness of breathing and body posture. A
continued focus upon body posture and breathing and body posture. A continued focus
upon body posture andbreathing in yoga serves to emphasize an awareness of the impact
of changing emotional states upon the body. In turn , Poonam singh stated that such
awareness serves to promote a more balanced equilibrium between the sympathetic and
39
parasympathetic autonomic nervous system and thus state of health. Another study
hypothyroidism patient concludes that yoga has beneficial effect on pulmonary function
test of hypothyroid, patients use to improve in their respiratory muscle strength and
increased air entry which increase oxygen concentration at tissue level(54,55).A study
sometimes called “the ocean breath”.Ujjayi is the diaphragmatic breath, which first fills
the lower belly( activating the first and second chakras)and finally moves into the upper
chest and throat. Inhalation and exhalation are both done through the nose. The “Ocean
sound” is created by moving the glottis as air passes in and out. As the throat passage is
narrowed it creates a rushing sound. The length and speed of the mind is also facilitated.
It has a positive effect on whole mind and body as particularly on nervous system. It
improves the functioning of all endocrine gland by its soothing effect especially thyroid
gland. It helps to secrete hormones from thyroid gland in required quantity.The study
concluded that yoga is valuable in helping the hypothyroidism patient to manage their
therapy in conjuction with medical therapy for the treatment of hypothyroid disorder. In
the Research study established that the yogic Asana,Pranayama and the kriyas are the
best and useful as they help not only to strengthen each organ and develop every muscle
of the body but also regulate the circulation of body blood, purity of lungs, inspire the
Pranayama is the science of respiration. The author of Hatha Pradipaka give eight
pranayama improves the circulation of blood can capable of producing very high pressure
momentarily with full inspiration, which is within the limits of an individual‘s comfort as
within the individual‘s limits of comfort with full exhalation. The incorporation of
beneficial for the individuals who are susceptible to ischemic heart disease and other
incremental, aids in accelerating the recovery processes initially after a person who
suffered with myocardial infarction. Even when the practice of pranayama has been
popularized only to a limited extend in Asian region, especially in India, there has been a
significant shift among the western society towards practicing yoga and pranayama over
41
UPANISHAD’S DEPICTION ON THE PRACTICE OF PRANAYAMA
There are several reports on ancient scripts that strongly supports the benefits of practice
of pranayama.
In prana all moveable and immoveable beings merge (during dissolution) and rise out of
exhalation when that is secured. Inhalation and exhalation are methods of inducing
retention. Retention is the key because it allows a longer period for the assimilation of
prana, just as it allows more time for the exchange of oxygen and carbon dioxide in the c
ells. As the breath is also intimately connected with various functions and organs of the
body as well as the mind, by controlling the breath we also influence all these
42
In the Hatha Yoga Pradipika(1:67) it has been said:
Asanas, various types of kumbhaka (pranayama) and the other various means of
illumination should all be practiced in the hatha yoga system until success in raja yoga is
attained.
When one attains the power of holding the breath for three hours, then certainly the
43
It is said in the Kathopanishad(2:3:2):
This whole world - whatever there is - vibrates having originated from prana.This cosmic
prana, also called mahaprana, came into being at the time of creation. Thus, in order to
fully understand prana, one must go back to the beginning of creation.The tranquillizing
practices of pranayama are designed to relax the body and mind, while simultaneously
YOGA
Yoga means ‘union’ or ‘connection’. In Sanskrit, the word ‘yoga’ is used to signify any
form of connection. Yoga is both a state of connection and a body of techniques that
The great sage Patanjali, in the system of Raja Yoga, gave one of the best definitions of
yoga. He said, ‘Yoga is the blocking (nirodha) of mental modifications (chitta vritti) so
that the seer (drashta) re-identifies with the (higher) Self. Patanjali’s system has come to
44
be the epitome of Classical Yoga Philosophy and is one of the 6 or 7 major philosophies
of India.
techniques (shat karmas) energy regulation techniques (mudra and bandha). The
definition of yoga in the Hatha Yoga texts is the union of the upward force (prana) and
the downward force (apana) at the navel center (manipura chakra). Hatha yoga teaches
us to master the totality of our life force, which is also called prana. By learning how to
feel and manipulate the life force, we access the source of our being.
Patanjali gives a wide range of techniques that slowly harmonizes the mind and gradually
induces more subtle perception. However, the main path of Patanjali is contained within
Dharana (concentration)
Dhyana (meditation)
Samadhi (superconsciousness)
These first five stages are the esoteric/bahiranga (external) practices of yoga. They
progressively prepare the body-mind for the last stages are the esoteric or antaranga
(internal) practices of yoga. The first five stages negate consciousness, whilst the last
45
1.10 PRANAYAMA
Practicing Pranayama helps in controlling the breath. The terminology was coined from
the two root words namely ‘prana’ meaning ‗vital energy‘ and ‗ayama’ meaning
breathing exercise; rather it aims at channeling the flow of excess oxygen into the lungs,
thereby, transporting it to all the systemic organs of the body.In the pranayama practices
there are four important aspects of breathing which are utilized. These are:
Pooraka or inhalation
Rechaka or exhalation
As Yoga was globally regarded as The ancient Indian science‘ which comprised of
different autonomic and cardiac responses among healthy humans. Many reports claimed
that the practice of pranayama aids in eliminating the toxins away from the body and
AnulomVilom Pranayama
Bahya Pranayama
Bhastrika Pranayama
Bhramari Pranayama
46
Digra Pranayama
Kapalbhati Pranayama
NadiSodhana Pranayama
Shitali Pranayama
Udgit Pranayama
Ujjayi Pranayama
Gheranda Samhita is a Sanskrit text of Yoga in Hinduism. It is one of the three classic
texts of hatha yoga . The Gheranda Samhita calls itself a book on ghatastha yoga, which
literally means "vessel yoga", wherein the body and mind are depicted as vessels that
carry and serve the soul (atman, purusha). The text teaches a seven limbed. Gheranda
Samhita is a step by step detailed manual of yoga taught by sage Gheranda to student
Chanda Unlike other hatha yoga texts, the Gheranda Samhita speaks of a sevenfold Yoga
Ujjayi Prananaya or the psychic breath soothes the mind and induces a meditative
state. Ujjayi means to ‘lift up’. In Ujjayi pranayama, the chest is slightly lifted up as if
the inhalation is done from the throat. Ujjayipranayama is mentioned in the yoga
Ujjayi involves a deep inhalation from both nostrils with a half closed glottis, so that a
faint hissing snoring sound is made during the inhalation. Then there is retention of
breath followed by exhalation. Those suffering from heart ailments and blood pressure
problems should avoid Kumbhaka or retention of breath. This practice should be learnt
47
4.0 MATERIALS AND METHODS
4.1SUBJECTS
A total of 120 subjects of both gender with age group ranging between 18 – 55 years
4.2 DESIGN
120 healthy volunteers of age group between 18 -55yrs will participate in the study. The
subjects will be recruited from the Out – patient department of Government Yoga and
48
4.6CRITERIA FOR DIAGNOSIS
Inclusion criteria
Both genders
yogic practice.
4.6.2Exclusion criteria:
disabilities
All subjects are free to withdraw from participation in the study at any time, for any reason,
specified or unspecified, and without prejudice to further yogic practices. Subjects who are
49
4.8 STUDY DESIGN PLAN:
50
4.9 ASSESSMENTS:
Yoga session for 12 weeks under supervision at Government yoga and naturopathy
medical college and hospital,each session lasting for about 15 minutes twice a day for 6
stimulating hormone] for the Patients will be measured before and after 12 week in control
hormone TSH]
Description :
Height: Using standard measuring tape, height in meters or centimeters or inches of each
patient.The boby mass index (BMI) is a value derived from the mass(weight) and height of
an individual.The BMI is defined as the body mass divided by the square of the body height
and is universally expressed in units of kg/m2, resulting from mass in kilograms ans height
in metres.
51
(b) Thyroid Function test:
Thyroid function tests(TFTs) is a collective term for blood tests used to check the function
of the thyroid.TFT is requested to patient who are throught to suffer from hyperthyroidism
in conditions linked to thyroid disease, such as atrial fibrillation and anxiety disorder.A TFT
Thyroid hormones
and decreased in hyperthyroidism. Its measurement is more sensitive test for thyroid
hormone function. TSH is produced in the pituitary gland. The production of TSH is
Total thyroxine
Total thyroxine is rarely measured, having been largely superseded by free thyroxine tests.
52
thyroid binding globulin(TBG).Total T4 is measured to see the bound and unbound level of
T4. The total T4 is less useful in cases where there could be protein abnormalities. The total
T4 is less accurate due to the large amount of T4 that is bound. The total T3 is measured in
clinical practice since the T3 has decreased amount that is bound as compared to T4.
Reference range depend upon method of analysis. Results should always be interpreted
using the range from the laboratory that performed the test.
Total triiodothyronine
Total triiodothyronine(Total T3) is rarely measured, having been largely superseded by free
hypothyroidism.
Ethical Clearance: The study was convened after obtaining approval from the
Informed Consent:
Subjects who fulfilled inclusion criteria were apprised about the purpose of the study
and their rights as research subjects. Informed consent form was administered in
English and time was given to each patient to go through the information sheet and
their queries were answered. Their right to withdraw any time from the study and the
need for willingness to participate voluntarily in the study was explained. The subjects
who expressed their willingness to participate in the study gave a signed informed. A
53
4.11 METHODOLOGY:
Men and women with hypothyroidism of age group between 18 - 55 years will participate in
the study.The patients will be referred by the In-patient and Out-patient department of Yoga
After obtaining informed consent, they will be subjected to general measures like BMI,
hormone] and they would be subjected to psychic breath for 15 minutes/ twice a day for 12
weeks, under the supervision of Department of Yoga and Naturopathy, Government Yoga
Step 3: Pre data measurement – BMI, Thyroid Function Test –[Tri-iodothyronine T3,
Step 5: Post data collection BMI, Thyroid Function Test –[ Tri-iodothyronine T3,
54
4.13STATISTICAL ANALYSIS:
Paired t test and one way ANOVA followed with post hoc test was performed to find the
55
5.0 RESULT:
Total of 120 hypothyroidism patient was included in the study out of that randomly 60
patients was chosen using simple random sampling to practice yoga for 90 days along with
conventional medicine and the other 60 patients was included in the control group only with
conventional medicine. Two samples in control group were not able to continue the study
completely due personal reason. Gender wise distribution among the yoga group and control
group was plotted in figure 1 and 2 respectively. Proportion of females were more in the
samples, this difference existed largely due to high prevalence of hypothyroidism among
females. The average age of the participants in yoga group was 40.21%. The average age of
56
Figure 11: Gender distribution between control and study group
Results of the pre and post measurements on T3, T4, TSH, Body weight and BMI among
Ujjayi pranayama along with standard drug group for a period of 90 days was tabulated in
Table.1. It shows that Body weight was reduced after practicing Ujjayi pranayama for the
study period. T3 got raised statistically significant after the yoga intervention where as T4
doesn’t show’s any statistical significance after the yoga intervention. Even though in yoga
intervention group T4 doesn’t show statistical significance its mean value raised to a marked
level from 8.05 to 8.54ng/ml This shows that Ujjayi pranayama is influencing the T4
secretion. TSH level reduced significantly after the practice of Ujjayi pranayama for a
period of 90 days.
57
Table 1: Representation of pre and post variables between groups
Paired Differences
Pre_Post
95% Confidence
Variables P
Std. Std. Error Interval of the t Df
Between Mean Value
Deviation Mean Difference
Groups
Lower Upper
58
Table 2. The Descriptive Analysis between groups
STUDY GROUP
Mean N Std. Deviation Std. Error Mean
59
Table 3: Equality of variances using independent T test.
95% Confidence
Interval of the
Mean Std. Error Difference
Differenc Differenc
F Sig. T Df P value e e Lower Upper
T3 Equal variances
assumed -0.923 116 0.358 -1.95640 2.11875 -6.15286 2.24006
3.632 0.059
Equal variances -0.908 57.085 0.368 -1.95640 2.15524 -6.27205 2.35925
not assumed
T4 Equal variances
116
assumed 1.243 0.216 0.63974 0.51467 -.37962 1.65910
2.917 0.090 108.59
Equal variances 1.238 0.218 0.63974 0.51668 -.38434 1.66382
0
not assumed
60
There was no statistical significant difference between the body mass index of interventional
group and control group but the mean value was less in interventional group than control
group. It shows that practicing ujjayi pranayama additionally leads to reduce body weight.
control group whereas T4 was statistically insignificant. There was a marked reduction of
61
6.0 DISCUSSION:
The result of this study revealed that practice of Ujjayi Pranayama decreases the Body mass
index and The Thyroid Function Test in the interventional group significantly in comparison
to that of the control group. There are many interventions to reduce severity of disease by
standard conventional treatment which is associated with multiple side effects and the
present study deals with non pharmacological mode of treatment. In this study, there is a
significant difference (p within the Study group) in the Body Mass Index , Thyroid
to their baseline data. However, no significant differences in Thyroxine (T4) within this
intervention group following the intervention. Overall, the practice of Ujjayi pranayama for
90 days among hypothyroid individuals has resulted in the reduction of the Body Mass
differences in Thyroxine (T4) ,although Ujjayi pranayama improved the quality of living
and confidence of the participants. The larger sample size is needed to gain better results.
62
7.0 CONCLUSION:
This study showed that 90 days of Ujjayi Pranayama reduced Body mass index and Thyroid
Thyroxine (T4) hypothyroid patients. This revealed that yoga practice has significant role in
improvement in the weight reduction. Further research need in this field with a larger
sample size and duration is warranted to reveal accurate changes in this field.
LIMITATIONS:
The current study was a pilot study comprising only of minimal number of subjects.
The outcome variable used in the study, cannot be inferred, or taken as an overall
mean, since the age and gender related factors could vary.
RECOMMENDATIONS:
The same study can be conducted on a larger population with suitable study design and
some objective kind of outcome variables could be included to validate the current result
63
8.0 SUMMARY:
The intended research work aims to evaluate the effect of 12 week Ujjayi pranayama on
Hypothyroidism in adults and to compare the changes in BMI and Thyroid Function Test
Psychic breathing technique .Many studies reported that the practice of yoga, especially
pranayama‘ influences BMI. The current study was conducted to determine the effect of
and Thyroid Function Test.The current research work employed A Randomized Controlled
Trail.In this study Potential subject will be screened and eligible patients will be recruited
for the study.A minimum of 60 participants in Study group and minimum of 60 participants
in Control group belonging within the age group of 18-55 participate in the study. After
obtaining informed consent both the group will be subjected to general measures like BMI,
Thyroid Function Test before and after the study. The study Group will be subjected to
Ujjayi Pranayama for 15 minutes twice a day for 6 days a week for 12 weeks. Results of the
pre and post measurements on T3, T4, TSH, Body weight and BMI among Ujjai pranayama
along with standard drug group for a period of 90 days was tabulated in Table.1. It shows
that Body weight was reduced after practicing ujjai pranayama for the study period. T3 got
raised statistically significant after the yoga intervention where as T4 doesn’t show’s any
statistical significance after the yoga intervention. Even though in yoga intervention group
T4 doesn’t show statistical significance its mean value raised to a marked level from 8.05 to
8.54 mg/dl .This shows that ujjai pranayama is influencing the T4 secretion. TSH level
64
reduced significantly after the practice of ujjai pranayama for a period of 90 days. This study
showed that 90 days of Ujjayi Pranayama reduced Body mass index and Thyroid
Thyroxine (T4) hypothyroid patients. This revealed that yoga practice has significant role in
improvement in the weight reduction. Further research need in this field with a larger
sample size and duration is warranted to reveal accurate changes in this field.
65
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10.0 ANNEXURE 1
1. I have read and understood this consent form and the information provided to me.
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5. I have been informed the investigator of all the treatments I am taking or have taken
in the past ________ months including any native (alternative) treatment.
6. I have been advised about the risks associated with my participation in this study.
7. I agree to cooperate with the investigator and I will inform him/her immediately if I
suffer unusual symptoms.
8. I have not participated in any research study within the past ________month(s).
9. I am aware of the fact that I can opt out of the study at any time without having to
give any reason and this will not affect my future treatment in this hospital.
10. I am also aware that the investigator may terminate my participation in the study at
any time, for any reason, without my consent.
11. I hereby give permission to the investigators to release the information obtained
from me as result of participation in this study to the sponsors, regulatory authorities,
Govt. agencies, and IEC. I understand that they are publicly presented.
12. I have understood that my identity will be kept confidential if my data are publicly
presented.
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I am aware that if I have any question during this study, I should contact the investigator.
By signing this consent form I attest that the information given in this document has been
clearly explained to me and understood by me, I will be given a copy of this consent
document.
Name and signature / thumb impression of the participant (or legal representative if
participant incompetent)
Name_________________________ Signature_________________
Date________________
Date _________________
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