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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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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
Received December 31, 2014; accepted February 23, 2016
Abstract
Background: A significant number of women in India are
suffering from hypothyroidism. Hypothyroidism is charac-
terized by elevated lipid profiles and thyroid stimulation
hormone (TSH). It leads many comorbid conditions such
as coronary artery disease, obesity, depression, osteoporo-
sis, sleep apnea, and etc. Yoga is proven to be effective in
reducing weight, dyslipidemia, depression and it brings the
balance in autonomous nervous system. We aimed to study
the effect of 6 months yoga practice on lipid profile, thyrox-
ine requirement and serum TSH in women suffering from
hypothyroidism.
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.
Methods: Twenty-two household women suffering from
hypothyroidism between the age range of 30 and 40
(mean ± SD; 36.7 ± 3.2) years, with average 4 ± 1.12-year his-
tory of hypothyroidism were included in this study. Subjects
with known cardiac issues, hypertension, history, recent sur-
gery, slip disc and low back pain were excluded from this
study. None of the subjects were on any other medication
except thyroxine which was kept during the intervention
phage (mean 65.78 ± 22.74 mcg). All the subjects underwent
6 months of yoga practice 1 h daily for 4 days a week. Lipid
profile, thyroxine dosage and serum TSH level were assessed
before and after intervention. Data was analyzed using paired
sample t test & Wilcoxon’s signed rank test.
Results: The paired sample t-test showed significant
reduction in total cholesterol (p = 0.006; –8.99 %), low-
density lipoprotein (LDL) (p = 0.002; –9.81 %) and
*Corresponding author: Kashinath G. M., Department of Yoga and
Life Sciences, S-VYASA University, Bangalore, Karnataka 560019,
India, E-mail: kgmhetre@gmail.com
Savithri Nilkantham, Nagaratna R., Nagendra H. R., Department of
Yoga and Life Sciences, S-VYASA University, Bangalore, Karnataka
560019, India
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J Complement Integr Med. 2016; aop
triglycerides (p = 0.013; –7.6 %), and there was a signifi-
cant improvement in high-density lipoprotein (HDL)
(p = 0.02; + 9.65 %) along with nonsignificant reduction
in TSH level (p = 0.452; –9.72 %). Wilcoxon signed-rank
test showed significant reduction in thyroxine medication
score (p = 0.029; –15.30 %) from.
Conclusion: 6 months practice of yoga may help in
improving cholesterol level, serum TSH, may also help
in reducing the thyroxine requirement in female patients
suffering from hypothyroidism. However, further rando-
mized controlled studies need to be conducted to confirm
the present finding.
Keywords: cholesterol, hypothyroidism, thyroid stimula-
tion hormone (TSH), thyroxine requirement, yoga.
Introduction
Hypothyroidism is one of the most common health con-
ditions characterized by hypo-functioning of the thyroid
gland [1]. It is believed to be a common health issue in
India and worldwide. The prevalence of hypothyroidism
is quite high, affecting approximately one in 10 out of 35
adults [2]. It is more prevalent in females and elder
population [3].
Hypothyroidism is characterized by increased level
of thyroid stimulation hormone (TSH) [4], triglycerides,
low-density lipoprotein (LDL) and reduced high-density
lipoprotein (HDL). Hence hypothyroidism is associated
with increased risk of atherosclerosis [5]. Management
of dyslipidemia, TSH level and thyroxine dosage is the
goal of conventional management of hypothyroidism in
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
increased chances of fractures [6]. This can also cause
spinal osteopenia [7].
Yoga is one of the most ancient sciences, which was
practiced by ancient Indians for the higher purposes like
self-realization Samadhi and gaining the higher powers
2 Savitri et al.: Yoga and hypothyroidism
called siddhis. Many scientific studies have been con-
ducted on different components of yoga like asana
(yogic physical postures), pranayama (yogic breathing
practices), meditation and yoga-based relaxation techni-
ques since last few decades. Studies reported health ben-
efitting effects of yoga in many diseased conditions like
diabetes, hypertension, asthma [8], depression, anxiety
[9] and etc.
Previous studies on yoga reported that yoga helps in
reducing the body mass index (BMI), total cholesterol
and free fat mass in obese individuals [10]; it also
reduces the triglycerides and improves HDL and overall
well-being. Hence, it has a potential role as add-on to
the modern medical management of hypothyroidism. In
earlier studies, yoga is found to be effective in improv-
ing the quality of life [3] and lung function [11] in
hypothyroidism subjects. In present study, we aimed to
see the effect of 6 months yoga practice on lipid profile,
thyroxine medication and TSH level in women with
hypothyroidism.
Materials and methods
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
Road, Bangalore, India.
Subjects with known cardiac disease, hypertension, history of
recent surgery, slip disc and low back pain were excluded from
this study. Thyroxine dosage was constant with an average dose
of 65.78 ± 22.74 mcg during the intervention phase. All the partici-
pants underwent 6 months of intense yoga practice, which included
asana (yogic physical postures), Suryanamaskar (Sun salutations),
pranayama (yogic breathing practice), yoga-based relaxation techni-
ques and meditation (see Table 2).
Lipid profile, serum TSH and thyroxine requirement were assessed
before and at the end of 6-month intervention. Thyroxine dosage
was reduced based on the serum TSH level by family endocrinolo-
gists for the respective subjects at the end of 6 months (see Table 1).
Table 1: Demographic details of subjects.
Subject, n Age Disease Thyroxine Comorbid
(mean ± SD), since dosage conditions
years (mean ± SD),
years
(mean ± SD),
mcg
 (females) . ± .  ± . . ± . Obesity,
disturbed
sleep,
dyslipidemia
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A written informed consent was obtained before the intervention
and subjects were explained in detail about the study in their
mother tongue.
Assessments
The pre–post-design was followed and lipid profile (total choles-
terol, triglycerides, HDL and LDL) and TSH level were assessed
before and after the intervention. Thyroxine dosage was changed
by endocrinologists on the basis of serum TSH levels at the end of 6
months.
All blood tests were done in the authentic laboratory.
Intervention
All the subjects underwent 6 months of yoga intervention, 1 h daily for 4
days in a week. Each class consists of opening prayer, loosening
practice asanas, Suryanamaskar (Sun salutation), pranayama, relaxa-
tion techniques and meditation (see Table 2).
All the practices included in this module were mainly focused on
weight reduction and enhancement of physical and mental well-
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,
Bhramari pranayama and so on help in the enhancement of physical
and mental relaxation and enhance the deep relaxation at physical
and mental levels.
Results
Data analysis was done using Statistical Package for
Social Sciences (SPSS) version 10. Baseline data of all
variables were found to be normally distributed by
Shapiro–Wilk test, except thyroxine medication score.
The paired sample t-test showed significant reduction
in total cholesterol (p = 0.006; –8.99 %), LDL (p = 0.002;
–9.81 %) and triglycerides (0.013; –7.6 %), and there
was a significant increase in HDL (p = 0.02; + 9.65 %).
Wilcoxon signed-rank test showed significant reduction
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-
cant (Table 3).
Discussion
In this study, we observed a significant reduction in total
cholesterol (8.99 %), LDL (9.81 %) and triglycerides
(7.65 %), and significant improvement in HDL cholesterol
(9.65 %). The mean thyroxine medication score was
 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
the study.
Previously, two studies have looked into the efficacy
of yoga in hypothyroidism. In a study on 20 hypothyroid-
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
of women with hypothyroidism [10]. These studies are
suggestive of positive role of yoga practice in hypothyr-
oidism. Similarly, in our pilot study we observed the
positive effect of yoga practice in hypothyroidism.
In earlier studies, 12 weeks of yoga intervention in
elderly women with diabetes showed significant reduc-
tion in triglycerides, total cholesterol, LDL and improved
HDL [15]. In another 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 [16].
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 trigly-
cerides, total cholesterol, LDL and increased HDL choles-
terol [17]. The pranayama, relaxation practices and
meditation are known to reduce stress and modulate the
hypothalamo-pituitary–adrenal axis [18]. Similarly, yoga
practice might influence the hypothalamo-pituitary–thyr-
oid axis and lead to decrease in serum TSH.
This study shows the potential role of yoga in the
management of hypothyroidism and preventions of car-
diac disease due to hypothyroidism.
Strengths
The strengths of the study are as follows: (i) to the best of
our knowledge this is the first study that assessed the
effect of yoga intervention on objective tools like TSH and
thyroxine medication score, and lipid profile in hypothyr-
oidism; (ii) long-term intervention; and (iii) good adher-
ence rate.
Limitations
This study has a few limitations: (i) lack of control group;
(ii) small sample size; and (iii) uni-gender, which restricts
the generalization.
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Future studies should include the randomized con-
trolled design with a larger sample size and other objec-
tive variables like BMI, cardiovascular parameters,
psychological variable along with thyroid hormones.
Conclusions
Long-term practice of yoga may help in improving cho-
lesterol level, serum TSH and thyroxine requirement in
female patients suffering from hypothyroidism. However,
further randomized controlled studies need to be con-
ducted to confirm the present finding.
Acknowledgments: The authors are thankful to all the
subjects who have participated in this study without
whose cooperation this study would not have been com-
pleted. We are grateful to all the endocrinologist who
have helped in monitoring the thyroxine medication in
the study.
Author contributions: All the authors have accepted
responsibility for the entire content of this submitted
manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played
no role in the study design; in the collection, analysis
and interpretation of data; in the writing of the report;
or in the decision to submit the report for publication.
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