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Global Journal of Research on Medicinal Plants & Indigenous Medicine || GJRMI ||
ISSN 2277-4289 | www.gjrmi.com | International, Peer reviewed, Open access, Monthly Online Journal
A COMPARATIVE CLINICAL EVALUATION OF THYROMAX POWDER
AGAINST THYROXINE SODIUM IN THE MANAGEMENT OF
HYPOTHYROIDISM
Ujjaliya Nitin1*, Krishnankutty S V
2, Remadevi R
3
1Assistant Prof., Dept. of Dravyaguna Vijnana, Shri Dhanwantry Ayurvedic College & Dabur Dhanwantry
Hospital, Chandigarh, India 2Head, Department of Internal medicine, Maulana Hospital, Perinthalmanna, Kerala, India
3Prof. & Head, Dept. of Dravyaguna Vijnana, V.P.S.V. Ayurveda College, Kottakkal, Kerala, India
*Corresponding Author: Email: [email protected]
Received: 06/12/2012; Revised: 01/01/2013; Accepted: 07/01/2013
ABSTRACT
The thyroid gland regulates metabolism of the body by virtue of its hormones. Insufficient levels
of thyroid hormone causes signs and symptoms such as slower metabolic rate, weight gain,
sleepiness, dry and cool skin, as well as others. This condition collectively can be called as
Hypothyroidism. Of the different types, Primary Hypothyroidism is the commonest which occurs
after destruction of thyroid follicles mainly because of autoimmunity. Hypothyroidism is most
common in women than men. According to a study, it affects 3.9% people with 9.4% subclinical
condition. The sole available treatment for this in conventional science is Hormone Replacement
Therapy which is not always free from side effects and has to be taken lifelong. This study was
aimed to search an option for Hypothyroidism in terms of herbs. Traditionally practiced drugs
Guducī Satvam (Tinospora cordifolia Miers.) and Āmalakī cūrnam (Phyllanthus emblica Linn.) was
taken in a combination named „Thyromax powder’ which was standardized before commencing with
clinical trial. A controlled clinical trial was planned with 20 newly diagnosed participants, which
were not exposed to any medicament, with Thyroxine sodium in control group and Thyromax
powder in study group for the duration of 3 month. Assessment was done on the basis of six
subjective parameters and thyroid function test. Statistically, study drug showed a positive
correlation on subjective parameters while control group showed significant result on T3 and T4
levels. Both the groups were found statistically insignificant on TSH level.
KEY WORDS: Thyromax powder, Hypothyroidism, Standardization, controlled clinical trial.
Research article
Cite this article:
Ujjaliya Nitin, Krishnankutty S V, Remadevi R (2013), A COMPARATIVE CLINICAL EVALUATION
OF THYROMAX POWDER AGAINST THYROXINE SODIUM IN THE MANAGEMENT OF
HYPOTHYROIDISM, Global J Res. Med. Plants & Indigen. Med., Volume 2(1): 52–64
Global J Res. Med. Plants & Indigen. Med. | Volume 2, Issue 1 | January 2013 | 52–64
Global Journal of Research on Medicinal Plants & Indigenous Medicine || GJRMI ||
INTRODUCTION
Endocrinology concerns the synthesis,
secretion and action of hormones. Hormones
are chemical messengers which have diverse
molecular structures and are related to
endocrine glands thereby coordinate the
activities of different cells. Some endocrine
disorders are common, particularly those of the
thyroid gland. At present thyroid diseases form
the second most common endocrine disorder in
India next to Diabetes mellitus. (Sir Stanley
Davidson, Davidson Principles & Practice of
Medicine; 2006). According to the report of N.
Kochupilli, thyroid disorders (5.4%) are the
most common among all the endocrine diseases
in India (N. Kochupillai et al., 1986).
Unfortunately many people may have this
disease and even not realize it. According to a
study known as a “Colorado thyroid disease
prevalence study” there may be as 13 million
Americans with an undiagnosed thyroid
condition (Gay J Canaris et al., 2000). In the
state of Kerala, India, 9.4% people who suffer
from hypothyroidism are asymptomatic
(Unnikrishnan AG et al., 2011). Wickham
Survey suggested that there is a high possibility
of developing Hypothyroidism in the
population with raised TSH and thyroid
antibodies. In the after follow up study it was
demonstrated to be much accurate. It was
inferred that increasing values of serum TSH
above 2mU/l increases the probability of
developing hypothyroidism which was further
increased in the presence of anti-thyroid
antibodies (Vanderpump MP, 1995). According
to a study anti-thyroid antibodies were found in
89.6% of the women between 15–35 years of
age and the overall prevalence of classical
Hypothyroidism was found to be 10 times more
than the men (K.P. Paulose, 2011). This made
the medical society to consider it with a higher
importance, as it may result in severe
complications. The possibility of incidence of
the disease also increases with a higher rate in
old age.
In Hypothyroidism, body function
decreases and this leads to a slow heart rate, an
increase in cholesterol level, mild anemia,
pervasive fatigue, depression, low body
temperature, cold intolerance, coarsening of
skin, muscles and joint aches, constipation,
weight gain, slow hair growth, loss of libido,
infertility, increased risk of miscarriage and
irregular menstrual cycle in women etc. In the
most common case of Hypothyroidism, namely
Primary Hypothyroidism resulting from an
intrinsic disorder of thyroid gland, serum T3
and T4 is low and TSH elevated also called as
classical Hypothyroidism, resulting above signs
and symptoms. (Sir Stanley Davidson,
Davidson Principles & Practice of Medicine;
2006).
According to the signs and symptoms, it is
concluded that Hypothyroidism is a resultant of
Vāta-kapha-medo vikrti and
Dhātvāgnimāndhya (Alsa mariyam
kalathancheri, 2008 and Chanchal Gupta,
2003). Guducī and Āmalakī are known for
Rasāyana property and have action on
Dhātvāgni specially Rasa and Rakta. Both the
drugs have been proven as immunomodulators
and anti-oxidant effects. (Dikshit V et al., 2003
and Shukla V et al., 2009). Prevalence of
autoimmune Hypothyroidism is much higher
(K.P. Paulose, 2001). Considering rejuvenative
effect of these herbs, they may rejuvenate
destroyed follicles of thyroid gland which are
responsible for production of thyroid
hormones; of course it is questionable and
needs further research. These are proved drugs
for many diseases and found non toxic. These
two drugs are not found to have any drug
interactions. (Database on Medicinal Plants
used in Ayurveda, 2005). Guducī Satvam
(extract of Tinospora cordifolia Miers.) along
with Āmalakī cūrnam (powder of fruit of
Phyllanthus emblica Linn.) is used by the
traditional vaidyas for Hypothyroidism in
Madhya Pradesh and found effective.
In modern medicine hormone supplement is
the only management for this disease. Though
it is thought to be a successful therapy but a
long term hormone therapy is not always free
from complications as well as side effects.
Most often it is needed to continue throughout
the life in adjusted doses.
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This study was an effort to evaluate the
effect of these two drugs in a combination
which is named as “Thyromax powder” on the
clinical symptoms and T3, T4 and TSH levels
of Hypothyroidism.
MATERIALS AND METHOD
Study design
The study design was a controlled clinical
trial. Randomization was not done due to two
different settings. Newly diagnosed participants
were selected as per the inclusion and exclusion
criteria. The control selected here was not a
concurrent control. The control group was
selected from an accessible population at
Maulana Hospital, Perinthalmanna, Kerala,
India. A detailed clinical examination was done
before and after the study using a prepared case
record form. Analysis of both the treatments
was done by evaluating subjective and
objective parameters.
Sample collection and preparation of study
drug
The fresh Stem of Tinospora cordifolia
were collected from nearby areas of Kottakkal,
Kerala, India. The stem cuttings were properly
identified in the department using external
morphological and histological characters.
Satvam was prepared as per the procedure
given in the text. (Yogaratnākara Rājayaksamā
Cikitsā; 328, Verse no. 1-11/2)
The fresh fruit of Phyllanthus emblica of
similar size were bought from market. The
fruits were identified in the department and
well dried in shade. Powder was prepared in the
size of 40–80 microns. (The Ayurvedic
Pharmacopoeia of India, 2001)
Physicochemical Standardization of
Thyromax powder
In the present study the combination of
Satvam of Tinospora cordifolia and fine
powder of dried fruits of Phyllanthus emblica
in the ratio of 1:3; given the name Thyromax
powder were subjected to preliminary
physicochemical screening for the
standardization of drug and extraction of plant
constituents.
(Quality Standards of Indian
medicinal Plants, and The Ayurvedic
Pharmacopoeia of India, 2001). (Table no. 2 -
4)
Phytochemical analysis
Quantification of characteristic compounds
The extracts obtained were subjected to
qualitative tests for the identification of various
plant constituents. (Quality Standards of Indian
medicinal Plants, 2003 and The Ayurvedic
Pharmacopoeia of India, 2001). (Table no. 5 -
7)
Thin Layer Chromatography & HPTLC
Selection of chromatographic layer
Pre-coated TLC silica gel 60 F254 (E.
Merck) plates on aluminum sheet were used for
chromatographic profile for individual drugs
and for Thyromax powder. TLC of all
successive solvent extractives of Thyromax
powder was prepared. While HPTLC
fingerprinting of methanolic extract of Guducī
Satvam, Āmalakī cūrnam and Thyromax
powder was prepared.
Selection of mobile phase for TLC
a] For Thyromax powder
Before the application of the samples to the
plates, an appropriate solvent system was
selected. The solvent system was chosen by the
trial and error method. The solvent systems
used for the TLC analysis were different for
different successive solvent extractives.
For Petroleum ether extract – n-hexane :
ethyl acetate : formic acid (10:2:0.2)
For Cyclohexane extractive – Toluene :
ethyl acetate : formic acid (8:2:0.2 )
For Acetone & Ethanol extract –
Toluene : ethyl acetate : formic acid
(5:5:1)
Selection of mobile phase for HPTLC
a] For Guducī Satvam
For methanolic extract – toluene : ethyl
acetate : formic acid (7:5:1)
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b] For Āmalakī cūrnam
For methanolic extract – toluene : ethyl
acetate : formic acid (7:5:1)
c] For Thyromax powder
For methanolic extract – toluene : ethyl
acetate : formic acid (7:5:1)
Application of sample
For the application of sample CAMAG
Automatic TLC sampler IV were used and the
concentration of sample extractives were
between 0.2 to 0.6 micro liters.
Pre-conditioning
Saturated chamber by lining with filter
paper for 30 minutes was prepared prior to
development for getting better Rf values. For
this CAMAG ADC-2 Automatic development
chamber was used.
Chromatographic development and drying
After development, the plates were taken
out and mobile phase was completely removed
from the plate by drying in vacuum desiccators.
Detection and visualization
Detection under UV light is the first choice
so plates were visualized in CAMAG TLC
Visualizer and photographs were taken in UV
254 and 365 nm. wavelength. Since very dim
spots were obtained in visible light, the TLC
plates were then sprayed with Anasaldehyde
sulphuric acid and dried in hot air oven at
110oC. The colors of the spots were recorded
and their positions were marked. The distance
travelled by each band was measured and
respective Rf values were calculated.
TLC analysis of Thyromax powder
For TLC study of Thyromax powder,
Petroleum ether, Cyclohexane, Acetone and
Ethanol extractives were spotted in the solvent
system given in the literature of TLC under
heading selection of solvent system. Eluents
were different for all extractives (common for
Acetone and Ethanol) hence Rf values, TLC
photographs are given separate.
HPTLC analysis
HPTLC profile was prepared for Guducī
Satvam, Āmalakī cūrnam and for the
combination Thyromax powder separately. The
mobile phase and extracts were different for
samples and has been mentioned earlier. For
Methanolic extract of Guducī Satvam and
Āmalakī cūrnam table of Rf value, TLC plate
photos and HPTLC over view and area graphs
are given separately.
Clinical study
In the present study randomization was not
done hence comparison of demographic details
and base line values of both the groups were
done. Comparison of response to the treatment
within both the groups was done. Total 20
participants were registered for the present
study, each 10 in study and control group. All
participants received full course of treatment
and completed their course successfully
without any interruption, hence there were no
dropouts in the study.
Data outcome were tabulated; mean
deviation, standard deviation and percentage
between the assessments were calculated.
Student „t‟ test was applied to find out level of
significance for all the parameters with in the
treatment and control group. The data were
statistically analyzed before and after
intervention.
RESULTS
Organoleptic characters
Detailed in (Table 1)
Powder microscopy Guducī satvam
Starch grains of Guducī showed deep blue
color when mounted with Iodine solution.
Every particle of Satvam was separated from
each other. The shapes of Satvam particle was
not similar and varies in size from other
particles. Starch grains of Guducī were
approximately 5.5–11.20µ in diameter and 6–
11.28µ in length. (Fig. no. 1&2).
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Powder microscopy of Āmalakī cūrnam
Powder showed hexagonal, thick, straight-
walled epidermal cells in surface view
embedded with small prismatic crystals of
silica; isolated or groups of thin-walled pitted
stone cells; fragments of thick walled fibers and
sclereids; fragments of pitted vessels, tracheids
and parenchyma, crystals of silica and simple
oval to spherical starch grains scattered as such
or embedded in the parenchymatous cells of the
mesocarp. (Fig.no.3-6) (The Ayurvedic
Pharmacopoeia of India).
Table 1. Organoleptic Characters
No. Characters Characteristics of Satvam Characteristics of Āmalakī cūrnam
1 Touch Fine and Smooth Rough
2 Color White Light grey
3 Taste Sweet Bitter, Sour and Sweet astringent
4 Odor Odorless Odorless
5 Consistency Fine powder Fine powder
Fig. 1–2 Powder Microscopy of Guducī Satvam
Fig. 3–6 Powder Microscopy of Āmalakī Cūrnam
Table 2. Physicochemical standards of Thyromax powder
Sr. No. Experiments Percentage
1. Total ash 3.05%
2. Water insoluble ash 2.23%
3. Acid insoluble ash 1.47%
4. Moisture content 11%
5. Volatile oil content 01%
6. Sugar content
a. Total Sugar 13.1%
b. Reducing sugar 7.23%
7. Fibre content 3.0%
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Table 3. Percentage of water soluble and alcohol soluble extractives
No. Name of extract Percentage of extract Color / Consistency
1. Hot water soluble 80.75% Blackish brown / Dry
2. Cold alcohol soluble 27.40% Dark brown / Oily
3. Hot alcohol soluble 50.00% Dark brown / Oily
Table 4. Successive solvent extractives
No. Experiments Percentage Color /Consistency
1. Petroleum ether 1.63 % Light yellow / Oily
2. Cyclohexane 0.80 % Lemon yellow/Oily
3. Acetone 12.0 % Dark brown / Oily
4. Ethanol 11.0 % Dark brown / Oily
Table 5. Qualitative Phytochemical analysis of the extractives
Solvent Steroid Alkaloids by Phenol Flavonoids Tannins
Mayer’s DDR
Petroleum ether + – + – – +
Cyclohexane – + + – – +
Acetone + – + + + +
Ethanol + – + + + +
Water + – – + + +
Cold alcohol + – + + + +
Hot alcohol + – + + + +
Table 6. Rf values of different spots of Thyromax powder
Petroleum ether
extract
Cyclohexane
extract
Acetone extract Ethanol extract
7 Spots 5 Spots 3 Spots 7 Spots
Colour of
Spot Rf Colour
of Spot
Rf Colour of
Spot
Rf Colour of Spot Rf
Violet 0.24 Purple 0.40 Brown 0.12 Pale brown 0.07
Violet 0.31 Purple 0.48 Brown 0.34 Pale brown 0.13
Violet 0.36 Purple 0.66 Light
violet
0.46 Pale brown 0.17
Violet 0.40 Violet 0.78 - - Pale brown 0.24
Pale pink 0.61 Violet 0.88 - - Brown 0.35
Violet 0.68 - - - - Light green 0.41
Pale
Violet
0.80 - - - - Light violet 0.49
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TLC of Thyromax powder (Fig. no. 7-18)
Fig. no. 7- 9: TLC plate of Petroleum ether extract of Thyromax powder
Fig. no. 10- 12: TLC plate of Cyclohexane extract of Thyromax powder
7: 254 nm 8: Derivatized plate. 9: 366 nm. 10: 254 nm. 11: Derivatized plate. 12: 366 nm.
Fig. no. 13- 15: TLC plates of Acetone extract of Thyromax powder
Fig. no. 16- 18: TLC plates of Ethanolic extracts of Thyromax powder
13: 254 nm 14: Derivatized plate. 15: 366 nm. 16: 254 nm. 17: Derivatized plate. 18: 366 nm.
Table 7. Rf value details of Methanolic extract of Guducī Satvam, Āmalakī cūrnam and
Thyromax powder.
Guducī Satvam Āmalakī cūrnam Thyromax powder
Spots Spots Spots
Color Rf Color Rf Color Rf
Light orange 0.80 Blue 0.18 Dark blue 0.18
Light orange 0.40 Blue 0.60
Light violet 0.70 Pink 0.70
Pink 0.80
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TLC of Āmalakī curnam and Guducī satvam (Fig. no. 19-23)
Fig. no. 19- 21: TLC plates of Methanolic extract
Fig. no. 22- 23: TLC plates of Methanolic extract of Thyromax powder.
19: Āmalakī at 254nm 20: Āmalakī at 366nm 21: Guducī at 366nm. 22: 254 nm 23: 366nm
HPTLC Over view graphs of study drugs (Fig. no. 24-31)
Fig. no. 24: Over view graph of Methanolic extract of Āmalakī at 254nm
Fig. no. 25: Area graph of Methanolic extract of Āmalakī at 254 nm.
Fig. no. 26: Over view graph of Methanolic extract of Guducī Satvam at 254 nm
Fig. no. 27: Area graph of Methanolic extract of Guducī Satvam at 254 nm
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Fig. no. 28: Over view graph of Methanolic extract of Thyromax powder at 254 nm
Fig. no. 29: Area graph of Methanolic extract of Thyromax powder at 254 nm
Fig. no. 30: Over view graph of Methanolic extract of Thyromax powder at 366 nm
Fig. no. 31: Area graph of Methanolic extract of Thyromax powder at 366 nm
Data related to response to the treatment
Graph 1. Effect of the treatment on weight gain Graph 2. Effect of the treatment on excessive sleep
00.20.40.60.8
11.21.4
BT AT
1.2
0.3
1.3 1.2
Effect of the treatment on weight
gain
Study
Control
0
0.5
1
1.5
2
2.5
BT AT
2.2
0.2
1.91.6
Effect of the treatment on
excessive sleep
Study
Control
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Graph 3. Effect of the treatment on muscle cramp Graph 4. Effect of the treatment on edema
Graph 5. Effect of the treatment on dry skin Graph 6. Effect of the treatment on constipation
Graph 7. Effect of the treatment on T3 parameter Graph 8. Effect of the treatment on T4 parameter
0
1
2
3
BT AT
2.2
0.2
2.0 1.7
Effect of the treatment on muscle
cramp
Study
Control
0
0.5
1
1.5
2
BT AT
1.8
0.4
1.31.1
Effect of the treatment on
edema
Study
Control
00.20.40.60.8
11.21.41.61.8
2
BT AT
2.0
0.6
1.5 1.4
Effect of the treatment on dry
skin
Study
Control
0
0.5
1
1.5
2
2.5
3
BT AT
2.8
0.0
2.4
2.1
Effect of the treatment on
constipation
Study
Control
0
0.2
0.4
0.6
0.8
1
BT AT
0.696 0.7190.658
0.822
Effect of the treatment on T3 parameter
Study
Control
0
10
20
30
40
50
60
70
BT AT
54.01 54.91
43.76
65.92
Effect of the treatment on T4 parameter
Study
Control
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Graph 9. Effect of the treatment on TSH
DISCUSSION
Pharmacognostical study
Moisture content of the shade dried drug
determined by Dean & Starks apparatus was
found to be 11%. Total ash of any drug is the
residue obtained on its complete incineration in
an electric Bunsen burner. This mainly
represents the inorganic salts present in the
drug, if the drug is pure and any impurities like
sand, soil etc. adhering to the drug will also
remain as ash, thus increasing the ash value
several fold. Ash value is the general criterion
to ascertain the purity of the drug. Total ash
value of the drug was found to be 3.05%. Water
insoluble ash mainly gives the percentage of
organic matter present in the ash and this was
found to be 2.23%. Acid insoluble ash, which
mainly gives the percentage of the sand and
impurities that remain insoluble in HCl and it
was found to be 1.47%. Water soluble extracts
of the drug mainly represents the percentage of
organic constituents such as tannins, sugars,
plant acids, mucilage and glycosides. Alcohol
soluble extracts mainly represents the
percentage of organic constituents such as
alkaloids, phenols, flavanoids, steroids, sugars
etc. present in the drug.
Successive solvent extraction, which is the
extraction of the drug with organic solvents of
increasing polarity, was applied for the
isolation of active constituents from the crude
drug. The highest percentage of extract was
obtained by the extraction with acetone (12.0
%) and least with the solvent cyclo-hexane 0.80
percent.
The extracts obtained by exhausting crude
drugs are indicative of approximate measure of
their chemical constituents. Successive
extraction showed scattered results because of
the combination of two drugs. Due to Āmalakī
cūrnam (Phyllanthus emblica) tannin present in
all the extracts and steroids are present in all
except cyclohexane extractive. While alkaloid
(by Mayer‟s reagent) is present only in
cyclohexane extract and alkaloid by
Dragendroff‟s reagent present in all except
water soluble extract. Phenol and flavonoids
are present in all the extract except petroleum
ether and cyclohexane extractives.
Clinical study
Student „t‟ test was applied to find out level
of significance for all the parameters with in
the treatment and control group. The data were
statistically analyzed before and after
intervention. Both the groups were not
compared since only study group showed
significant improvement on subjective
parameters and only control group showed
0
10
20
30
40
50
60
70
BT AT
55.99
23.46
62.79
8.17
Effect of the treatment on TSH
Study
Control
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significant improvement on T3 and T4 level.
None of them showed significant effect on TSH
parameter.
Probable Mode of Action in a nut shell
It has been established for a very long time
that there is a complex relationship between
thyroid disease, body weight and metabolism.
(K.P. Paulose, 2011). Thyroid hormones
regulate metabolism in human. It is also
reported that difference in BMRs are associated
with changes in energy balance. (K.P. Paulose,
2011). Studies concluded that under secretion
of thyroid hormones leads to low BMR and
thereby weight gain, decrease in energy balance
causes sleepiness and muscle cramps. Once the
drug holds the body metabolism all these
symptoms get relieved. Functions of thyroid
hormone have a close resemblance to the
Dhātvāgni (digestive potency of cells). (Alsa
mariyam kalathancheri, 2008). Constipation is
the foremost symptom of this disease which
may be due to Agnimāndhya (loss of appetite)
and Āma (indigested food material). Both the
drugs are considered most excellent Pitta
śamakas (drugs which mollify Pitta) and hence
balance the Pitta and regularize the Dhātvāgni.
Madhura (sweet) and Amlarasa (sore), Snigdha
guna, Madhura Vipāka and Usna Vīrya
(warmth in potency) of drugs simply mollify
the aggravated Vāta. Kasāya rasa, Ruksa guna
and Usna Vīrya eliminate the kapha in channels
and also help in improving Agni. Once Agni get
normalized, the signs and symptoms of
Hypothyroidism like constipation, weight gain,
excessive sleep and muscle cramp all get
relieved. Guducī Satvam having Snigdha guna
and Madhura rasa reduces the dryness of skin.
Āmalakī cūrnam by virtue of its Ruksa guna
reduces the excess accumulated water in case
of Hypothyroidism which is the main cause of
weight gain.
Study drugs, Guducī Satvam and Āmalakī
cūrnam both having Rasāyana properties are
best for longstanding disease like
Hypothyroidism. In case of primary
Hypothyroidism, the anomaly happens is in
thyroid gland itself. The under-production of
thyroid hormones leads to increased TSH from
pituitary and various signs and symptoms.
Considering rejuvenative property of drugs,
their outcome can be justified. Being pitta
śamana, they reduce inflammatory changes;
being vāta śamana (drugs which mollify vāta)
may reverse the condition of destroyed thyroid
follicles or hold up the follicles to amplify the
liberation of hormones. Anti-oxidant and
immuno-modulatory effect of these drugs helps
in this action.
CONCLUSION
HPTLC finger print showed more than four
chemical constituents present in Guducī
Satvam. HPTLC finger print showed 11 peaks
may represent chemical constituents present in
Āmalakī cūrnam. There is no negative
impression in HPTLC profile of Thyromax
powder due to combination of two herbs.
Thyromax powder is found to be more effective
in reducing the subjective parameters.
Thyroxine sodium is found to be more effective
on T3 and T4 parameters. Thyromax powder
and Thyroxine sodium both are found to be
insignificant on TSH level parameter.
REFERENCES
Alsa mariyam kalathancheri (2008). Ayurvedic
perspective on endocrinology with
special reference to Hyperthyroidism
and Hypothyroidism. Thesis submitted
to Kerala University,
Thiruvananthapuram.
Anonymous, Indian Council for Medical
Research, New Delhi (2003).
Appendix I and II, Quality Standards
of Indian medicinal Plants. Vol. 1, 1st
edition.235–37.
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