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Effect of 6 months intense Yoga practice on lipid profile, thyroxine

medication and serum TSH level in women suffering from hypothyroidism: A
pilot study

Article  in  Journal of Complementary and Integrative Medicine · April 2016

DOI: 10.1515/jcim-2014-0079

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 J Complement Integr Med. 2016; aop

Savithri Nilkantham, Kashinath G. M.*, Nagaratna R. and Nagendra H. R.

Effect of 6 months intense Yoga practice on lipid

profile, thyroxine medication and serum TSH level
in women suffering from hypothyroidism: A pilot
study
DOI 10.1515/jcim-2014-0079 triglycerides (p = 0.013; –7.6 %), and there was a signifi-
Received December 31, 2014; accepted February 23, 2016 cant improvement in high-density lipoprotein (HDL)
(p = 0.02; + 9.65 %) along with nonsignificant reduction
Abstract
in TSH level (p = 0.452; –9.72 %). Wilcoxon signed-rank
Background: A significant number of women in India are test showed significant reduction in thyroxine medication
suffering from hypothyroidism. Hypothyroidism is charac- score (p = 0.029; –15.30 %) from.
terized by elevated lipid profiles and thyroid stimulation Conclusion: 6 months practice of yoga may help in
hormone (TSH). It leads many comorbid conditions such improving cholesterol level, serum TSH, may also help
as coronary artery disease, obesity, depression, osteoporo- in reducing the thyroxine requirement in female patients
sis, sleep apnea, and etc. Yoga is proven to be effective in suffering from hypothyroidism. However, further rando-
reducing weight, dyslipidemia, depression and it brings the mized controlled studies need to be conducted to confirm
balance in autonomous nervous system. We aimed to study the present finding.
the effect of 6 months yoga practice on lipid profile, thyrox-
ine requirement and serum TSH in women suffering from Keywords: cholesterol, hypothyroidism, thyroid stimula-
hypothyroidism. tion hormone (TSH), thyroxine requirement, yoga.
Objective: To practice on study the effect of 6 months
yoga practice on lipid profile, thyroxine requirement and
serum TSH in women suffering from hypothyroidism. Introduction
Methods: Twenty-two household women suffering from
hypothyroidism between the age range of 30 and 40 Hypothyroidism is one of the most common health con-
(mean ± SD; 36.7 ± 3.2) years, with average 4 ± 1.12-year his- ditions characterized by hypo-functioning of the thyroid
tory of hypothyroidism were included in this study. Subjects gland [1]. It is believed to be a common health issue in
with known cardiac issues, hypertension, history, recent sur- India and worldwide. The prevalence of hypothyroidism
gery, slip disc and low back pain were excluded from this is quite high, affecting approximately one in 10 out of 35
study. None of the subjects were on any other medication adults [2]. It is more prevalent in females and elder
except thyroxine which was kept during the intervention population [3].
phage (mean 65.78 ± 22.74 mcg). All the subjects underwent Hypothyroidism is characterized by increased level
6 months of yoga practice 1 h daily for 4 days a week. Lipid of thyroid stimulation hormone (TSH) [4], triglycerides,
profile, thyroxine dosage and serum TSH level were assessed low-density lipoprotein (LDL) and reduced high-density
before and after intervention. Data was analyzed using paired lipoprotein (HDL). Hence hypothyroidism is associated
sample t test & Wilcoxon’s signed rank test. with increased risk of atherosclerosis [5]. Management
Results: The paired sample t-test showed significant of dyslipidemia, TSH level and thyroxine dosage is the
reduction in total cholesterol (p = 0.006; –8.99 %), low- goal of conventional management of hypothyroidism in
density lipoprotein (LDL) (p = 0.002; –9.81 %) and order to reduce the complications and comorbidities.
Studies reported that thyroid hormone therapy leads
to a decrease in bone mineral density, which may lead to
*Corresponding author: Kashinath G. M., Department of Yoga and increased chances of fractures [6]. This can also cause
Life Sciences, S-VYASA University, Bangalore, Karnataka 560019,
spinal osteopenia [7].
India, E-mail: kgmhetre@gmail.com
Savithri Nilkantham, Nagaratna R., Nagendra H. R., Department of Yoga is one of the most ancient sciences, which was
Yoga and Life Sciences, S-VYASA University, Bangalore, Karnataka practiced by ancient Indians for the higher purposes like
560019, India self-realization Samadhi and gaining the higher powers

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2 Savitri et al.: Yoga and hypothyroidism

called siddhis. Many scientific studies have been con- A written informed consent was obtained before the intervention
ducted on different components of yoga like asana and subjects were explained in detail about the study in their
(yogic physical postures), pranayama (yogic breathing mother tongue.
practices), meditation and yoga-based relaxation techni-
ques since last few decades. Studies reported health ben- Assessments
efitting effects of yoga in many diseased conditions like
The pre–post-design was followed and lipid profile (total choles-
diabetes, hypertension, asthma [8], depression, anxiety terol, triglycerides, HDL and LDL) and TSH level were assessed
[9] and etc. before and after the intervention. Thyroxine dosage was changed
Previous studies on yoga reported that yoga helps in by endocrinologists on the basis of serum TSH levels at the end of 6
reducing the body mass index (BMI), total cholesterol months.
and free fat mass in obese individuals [10]; it also All blood tests were done in the authentic laboratory.

reduces the triglycerides and improves HDL and overall

well-being. Hence, it has a potential role as add-on to Intervention
the modern medical management of hypothyroidism. In
earlier studies, yoga is found to be effective in improv- All the subjects underwent 6 months of yoga intervention, 1 h daily for 4
ing the quality of life [3] and lung function [11] in days in a week. Each class consists of opening prayer, loosening
hypothyroidism subjects. In present study, we aimed to practice asanas, Suryanamaskar (Sun salutation), pranayama, relaxa-
see the effect of 6 months yoga practice on lipid profile, tion techniques and meditation (see Table 2).
All the practices included in this module were mainly focused on
thyroxine medication and TSH level in women with
weight reduction and enhancement of physical and mental well-
hypothyroidism. being. Physical postures, Suryanamaskar, and dynamic yogic
breathing practices like Bhastrika and Kapalabhati pranayama help
in increasing the physical activity and metabolic rate, and slow
breathing practices like Nadi Shuddhi pranayama, Ujjayi pranayama,
Materials and methods Bhramari pranayama and so on help in the enhancement of physical
and mental relaxation and enhance the deep relaxation at physical
and mental levels.
Twenty-two household women with hypothyroidism within the age
range of 30–40 (mean ± SD; 36.7 ± 7.2 years), with 3–5 (mean ± SD;
4 ± 1.12)-year history of hypothyroidism were included in this study.
All the subjects were residents of Springfield Apartment, Sarjapur Results
Road, Bangalore, India.
Subjects with known cardiac disease, hypertension, history of Data analysis was done using Statistical Package for
recent surgery, slip disc and low back pain were excluded from
Social Sciences (SPSS) version 10. Baseline data of all
this study. Thyroxine dosage was constant with an average dose
of 65.78 ± 22.74 mcg during the intervention phase. All the partici- variables were found to be normally distributed by
pants underwent 6 months of intense yoga practice, which included Shapiro–Wilk test, except thyroxine medication score.
asana (yogic physical postures), Suryanamaskar (Sun salutations), The paired sample t-test showed significant reduction
pranayama (yogic breathing practice), yoga-based relaxation techni- in total cholesterol (p = 0.006; –8.99 %), LDL (p = 0.002;
ques and meditation (see Table 2).
–9.81 %) and triglycerides (0.013; –7.6 %), and there
Lipid profile, serum TSH and thyroxine requirement were assessed
before and at the end of 6-month intervention. Thyroxine dosage
was a significant increase in HDL (p = 0.02; + 9.65 %).
was reduced based on the serum TSH level by family endocrinolo- Wilcoxon signed-rank test showed significant reduction
gists for the respective subjects at the end of 6 months (see Table 1). in thyroxine medication score (p = 0.029; –15.30 %)
from baseline. There was a reduction in TSH level
(p = 0.452; –9.72 %) which was not statistically signifi-
Table 1: Demographic details of subjects. cant (Table 3).

Subject, n Age Disease Thyroxine Comorbid

(mean ± SD), since dosage conditions
years (mean ± SD),
years
(mean ± SD),
mcg
Discussion
 (females) . ± .  ± . . ± . Obesity, In this study, we observed a significant reduction in total
disturbed cholesterol (8.99 %), LDL (9.81 %) and triglycerides
sleep,
(7.65 %), and significant improvement in HDL cholesterol
dyslipidemia
(9.65 %). The mean thyroxine medication score was

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 Savitri et al.: Yoga and hypothyroidism 3

250
Lipid profile
200
Mean scores

150
Pre
100 Post

50
Figure 1: Pre- and post-changes
0 in mean and SD in lipid profile after
Total cholesterol Triglycerides HDL LDL 6 months of yoga intervention.

100 Thyroxine medication score

Mean thyroxine dose

80
60
(mcg)

40 Pre
20 Post
Figure 2: Pre- and post-changes
0 in mean and SD in thyroxine medication
Pre Post after 6 months of yoga intervention.

6 Serum TSH
Mean serum TSH level

5
4
(mIU/L)

3 Pre
2
Post
1 Figure 3: Pre- and post-changes
0 in mean and SD in serum TSH levels
Pre Post after 6 months of yoga intervention.

Table 3: Pre- and post-changes in lipid profile, TSH and thyroxine

Table 2: List of the practices given. medication score after 6 months of yoga intervention.

Starting prayer Variables Pre (Mean ± SD) Post (Mean ± SD) p Value change, %
Sukshma Vyayama–Sithilikarna Vyayama
TL . ± . . ± . .** –.
Hands in and out breathing, hands stretch breathing, Kapola Shakti Vikasaka
TR . ± . . ± . .** –.
(for cheeks/mouth), Griva Shakti Vikasaka (for Neck), Anguli Shakti Vikasaka
HDL . ± . . ± . .* .
(for fingers), etc. []
LDL . ± . . ± . . –.
Suryanamaskar  sets followed by deep relaxation techniques (DRT) []
TSH . ± . . ± . . –.
Special techniques
Thyroxine . ± . . ± . .* –.
Mind, sound resonance technique []/cyclic meditation [] once in a week
Balancing postures
TL-Total Cholesterol, TR-Triglycerides, HDL- High Density lipoprotein,
Bakasana, Vrikshasana, Sirsasana, Natarajasana, Ujjayi pranayama, Ardha
LDL-Low density lipoprotein, TSH-Thyroid Stimulating Hormone;
Matsyendrasana twist, Vashishtasana twist, Ardha Padmasana twist, *
p < 0.05 level, p** < 0.001 level.
Bhujangasana, Shalabhasana, Dhanurasana, Halasana, Matsyasana,
Simha Mudra, Shashankasana
Pranayama and Kriyas significantly reduced by 15.30 %, where no significant
Nadi Shuddhi pranayama, Vibhagya pranayama, Bhastrika, Kapalabhati, reduction was seen in serum TSH.
Bhramri, Ujjayi pranayama []
Out of 22 subjects, seven subjects could be able to reduce
Closing prayer
their thyroxine medication dosage, no increase in thyroxine

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4 Savitri et al.: Yoga and hypothyroidism

medication was observed in any of the subjects at the end of Future studies should include the randomized con-
the study. trolled design with a larger sample size and other objec-
Previously, two studies have looked into the efficacy tive variables like BMI, cardiovascular parameters,
of yoga in hypothyroidism. In a study on 20 hypothyroid- psychological variable along with thyroid hormones.
ism women, 1 month of yoga practice showed significant
improvement in the quality of life [3], and in another
study, 6 months of pranayama (yogic breathing) practice
improved forced expiratory volume in lung function test
Conclusions
of women with hypothyroidism [10]. These studies are
Long-term practice of yoga may help in improving cho-
suggestive of positive role of yoga practice in hypothyr-
lesterol level, serum TSH and thyroxine requirement in
oidism. Similarly, in our pilot study we observed the
female patients suffering from hypothyroidism. However,
positive effect of yoga practice in hypothyroidism.
further randomized controlled studies need to be con-
In earlier studies, 12 weeks of yoga intervention in
ducted to confirm the present finding.
elderly women with diabetes showed significant reduc-
tion in triglycerides, total cholesterol, LDL and improved
HDL [15]. In another randomized control trial, 6 months Acknowledgments: The authors are thankful to all the
of yoga nidra (yogic relaxation method) practice was subjects who have participated in this study without
shown to reduce the serum TSH level in females with whose cooperation this study would not have been com-
menstrual abnormalities [16]. pleted. We are grateful to all the endocrinologist who
In our study also we found similar results as that of have helped in monitoring the thyroxine medication in
the previous one. the study.
The exact mechanism behind these finding is not Author contributions: All the authors have accepted
known. One of the possible mechanisms could be responsibility for the entire content of this submitted
increased physical activity due to Suryanamaskar and manuscript and approved submission.
physical postures might have helped in reducing trigly- Research funding: None declared.
cerides, total cholesterol, LDL and increased HDL choles- Employment or leadership: None declared.
terol [17]. The pranayama, relaxation practices and Honorarium: None declared.
meditation are known to reduce stress and modulate the Competing interests: The funding organization(s) played
hypothalamo-pituitary–adrenal axis [18]. Similarly, yoga no role in the study design; in the collection, analysis
practice might influence the hypothalamo-pituitary–thyr- and interpretation of data; in the writing of the report;
oid axis and lead to decrease in serum TSH. or in the decision to submit the report for publication.
This study shows the potential role of yoga in the
management of hypothyroidism and preventions of car-
diac disease due to hypothyroidism.

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