Conjunctivitis (also called pink eye in North America or Madras eye in India) is inflammation of the conjunctiva (the outermost layer of the eye and the inner surface of the eyelids).It is commonly due to an infection (usually viral, but sometimes bacterial) or an allergic reaction.

1. ISHAN INSTITUTE OF MANAGEMENT AND
TECHNOLOGY
GREATER NOIDA
“HEALTH IS WEALTH”
CONJUNCTIVITIS
and
HYPERTHYROIDISM
(Submitted in Partial fulfilment of the Requirement for Post
Graduate Diploma in BUSINESS MANAGEMENT “2014-2016”)
UNDER THE GUIDANCE OF
Mrs. REETA Mam
(Faculty, Social Research Methodology)
SUBMITTED TO: SUBMITTEDBY:
Dr. D.K.Garg UTSAV KUNDU
CHAIRMAN SIR ENR No-20006

2. 1
ACKNOWLEDGEMENT
I owe my gratitude to our chairman Sir (DR.D.K GARG), for
providing me the opportunity to do this assignment.
It is my foremost duty to express my deep sense of gratitude
and respect to Mrs. REETA MAM for her valuable guidance,
sharing her insights on the topic and for being a constant
source of inspiration.

3. 2
UTSAV KUNDU
TABLE OF CONTENTS
S.N PARTICULARS PAGE NO.
01 ACKNOWLEDGMENT 1
Conjunctivitis
02 INTRODUCTION 3
05 CAUSES 4-5
06 SYMPTOMS 6-7
07 TREATMENT 8-10
08 AYURVEDIC REMEDIES 11-14
09 COST OF TREATMENT 15
10 SUGGESTION 16
Hyperthyroidism
11 INTRODUCTION 17
CAUSES 18
12 SYMPTOMS 19-21
TREATMENT 22-24
13 AYURVEDIC REMEDIES 25-27
14 COST OF TREATMENT 28
15 BIBLIOGRAPHY 29
16 CONCLUTION 30

4. 3
Conjunctivitis
INTRODUCTION
Conjunctivitis (also called pink eye in North America or Madras eye in
India) is inflammation of the conjunctiva (the outermost layer of the eye and the
inner surface of the eyelids).It is commonly due to an infection (usually viral,
but sometimes bacterial) or an allergic reaction.
Conjunctivitis is swelling of the thin, clear layer that covers the white of
your eye and lines your eyelid (the conjunctiva). It’s sometimes called pink eye.
The two most common types of conjunctivitis are infective (viral and
bacterial) and allergic conjunctivitis. Infective conjunctivitis makes up just over
a third of all eye problems in the UK each year. Over half of all visits to the GP
for eye problems are due to forms of conjunctivitis.
A former superintendent of the Regional Institute of Ophthalmology in
the city of Madras (the present-day Chennai) in India, Kirk Patrick, was the first
to have found the adenovirus that caused conjunctivitis, leading to the name
Madras eye for the disease.

5. 4
Causes
Conjunctivitis when caused by an infection is most commonly caused by
a viral infection. Bacterial infections, allergies, other irritants and dryness are
also common causes. Both bacterial and viral infections are contagious and
passed from person to person, but can also spread through contaminated objects
or water.
The most common cause of viral conjunctivitis is adenoviruses. Herpetic
keratoconjunctivitis (caused by herpes simplex viruses) can be serious and
requires treatment with acyclovir. Acute hemorrhagic conjunctivitis is a highly
contagious disease caused by one of two enteroviruses, Enterovirus 70 and
Coxsackievirus A24. These were first identified in an outbreak in Ghana in
1969, and have spread worldwide since then, causing several epidemics.
The most common causes of acute bacterial conjunctivitis are
Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus
influenzae. Though very rare, hyperacute cases are usually caused by Neisseria
gonorrhoeae or N. meningitidis. Chronic cases of bacterial conjunctivitis are
those lasting longer than 3 weeks, and are typically caused by Staphylococcus
aureus, Moraxella lacunata, or gram-negative enteric flora.
Neotrombicula autumnalis (trombiculid mite) in contact with the upper
eyelid margin, inducing conjunctivitis.An exceptional case of conjunctivitis
induced by a trombiculid mite (Neotrombicula autumnalis) was reported in
2013.
Conjunctivitis is part of the triad for Reiter's syndrome, a manifestation of
reactive arthritis, which is thought to be caused by autoimmune cross-reactivity
following certain bacterial infections. Reactive arthritis is highly associated with
HLA-B27. Conjunctivitis is associated with the autoimmune disease relapsing
polychondritis.
Allergic conjunctivitis :- It caused by allergens such as pollen, perfumes,
cosmetics, smoke, dust mites, Balsam of Peru (used in food and drink for
flavouring, in perfumes and toiletries for fragrance, and in medicine and
pharmaceutical items for healing properties), and eye drops. A patch test is used
to diagnose it and identify the causative allergen.

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Viral conjunctivitis :- Viruses are a common cause of conjunctivitis. The virus
most often associated with conjunctivitis also causes the common cold
(adenovirus). You may have infective conjunctivitis if you have a cold or have
come into contact with somebody who is coughing or sneezing. Viral
conjunctivitis typically affects both eyes and may cause a lots of watery
discharge too.
Bacterial conjunctivitis :-
Anyone can get bacterial conjunctivitis by:
1. Coming into contact with somebody who already has conjunctivitis.
2. Having recently had an upper respiratory infection, such as a common
cold.
3. Wearing contact lenses which have become infected.
4. Touching your eyes with unwashed hands.
5. Using eye makeup.
6. And facial lotions that are contaminated.
Neonatal conjunctivitis :- It affects new-born babies (within the first month of
life). It’s different to conjunctivitis that babies may develop as they get older.
One of the most common causes is by an infection passed on by the baby’s
mother if she has chlamydia or gonorrhoea when giving birth. This can happen
even if the mother has no symptoms of infection. Neonatal conjunctivitis can
cause permanent eye damage if it isn’t treated quickly.
Irritant (chemical) conjunctivitis :-
Chemical conjunctivitis can be caused by a number of things including:
1. Irritant chemicals

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2. Chlorine in a swimming pool
3. Air pollution
4. Contact lenses and their cleaning solutions
Symptoms
Red eye (hyperaemia), swelling of conjunctiva (chemosis) and watering
(epiphora) of the eyes are symptoms common to all forms of conjunctivitis.
However, the pupils should be normally reactive, and the visual acuity normal.
Viral :- Viral conjunctivitis is often associated with an infection of the upper
respiratory tract, a common cold, and/or a sore throat. Its symptoms include
excessive watering and itching. The infection usually begins with one eye, but
may spread easily to the other. Viral conjunctivitis shows a fine, diffuse
pinkness of the conjunctiva, which is easily mistaken for the ciliary infection of
Iris (Iritis), but there are usually corroborative signs on microscopy, particularly
numerous lymphoid follicles on the tarsal conjunctiva, and sometimes a
punctate keratitis.
Bacterial :- Bacterial conjunctivitis causes the rapid onset of conjunctival
redness, swelling of the eyelid, and mucopurulent discharge. Typically,
symptoms develop first in one eye, but may spread to the other eye within 2–5
days. Bacterial conjunctivitis due to common pyogenic (pusproducing) bacteria
causes marked grittiness/irritation and a stringy, opaque, greyish or yellowish
mucopurulent discharge that
may cause the lids to stick
together, especially after
sleep. Severe crusting of the
infected eye and the
surrounding skin may also
occur. The gritty and/or
scratchy feeling is sometimes
localized enough for patients
to insist they must have a
foreign body in the eye. The
more acute pyogenic
infections can be painful. Common bacteria responsible for nonacute bacterial
conjunctivitis are Staphylococci and Streptococci. Bacteria such as Chlamydia
trachomatis or Moraxella can cause a nonexudative but persistent conjunctivitis
without much redness. Bacterial conjunctivitis may cause the production of
membranes or pseudomembranes that cover the conjunctiva. Pseudomembranes
consist of a combination of inflammatory cells and exudates, and are loosely
adherent to the conjunctiva, while true membranes are more tightly adherent

8. 7
and cannot be easily peeled away. Cases of bacterial conjunctivitis that involve
the production of membranes or pseudomembranes are associated with
Neisseria gonorrhoeae, haemolytic streptococci, and C. diphtheriae.
Corynebacterium diphtheriae causes membrane formation in conjunctiva of
nonimmunized children.
Allergic :-
Allergic conjunctivitis is inflammation of the conjunctiva (the membrane
covering the white part of the eye) due
to allergy. Allergens differ among
patients. Symptoms consist of redness
(mainly due to vasodilation of the
peripheral small blood vessels), oedema
(swelling) of the conjunctiva, itching,
and increased lacrimation (production
of tears). If this is combined with
rhinitis, the condition is termed "allergic
rhinoconjunctivitis". The symptoms are
due to release of histamine and other
active substances by mast cells, which stimulate dilation of blood vessels,
irritate nerve endings, and increase secretion of tears.
Chemical :-
Chemical eye injury is due to either an acidic or alkali substance getting in the
eye. Alkalis are typically worse than acidic burns. Mild burns will produce
conjunctivitis, while more severe burns may cause the cornea to turn white.[12]
Litmus paper is an easy way to rule out the diagnosis by verifying that the pH is
within the normal range of 7.0—7.2. Large volumes of irrigation is the
treatment of choice and should continue until the pH is 6—8. Local anaesthetic
eye drops can be used to decrease the pain.
Irritant or toxic conjunctivitis show primarily
marked redness. If due to splash injury, it is
often present in only the lower conjunctival sac.
With some chemicals, above all with caustic
alkalis such as sodium hydroxide, there may be
necrosis of the conjunctiva with a deceptively
white eye due to vascular closure, followed by
sloughing of the dead epithelium. This is likely to be associated with slit-lamp
evidence of anterior uveitis.
Others:-

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Inclusion conjunctivitis of the newborn (ICN) is a conjunctivitis that may be
caused by the bacteria Chlamydia trachomatis, and may lead to acute, purulent
conjunctivitis. However, it is usually self-healing.
Conjunctivitis is identified by irritation and redness of the conjunctiva. Except
in obvious pyogenic or toxic/chemical conjunctivitis, a slit lamp
(biomicroscope) is needed to have any confidence in the diagnosis. Examination
of the tarsal conjunctiva is usually more diagnostic than the bulbar conjunctiva.
TREATMENT
Infective conjunctivitis
Most cases of infective conjunctivitis do not require medical treatment
and will clear up in one to two weeks.
Selfcare:-
There are several ways that you can treat infective conjunctivitis at home.
The following advice should help ease your symptoms:
Remove your contact lenses. If you wear contact lenses, take them out until all
the signs and symptoms of the infection have gone. Avoid using contact lenses
until 24 hours after you have finished a course of treatment. Do not reuse the
lenses after the infection has passed as the old lens could be a potential source
of reinfection.
Use lubricant eye drops. These are available over the counter at
pharmacies or they may be prescribed for you. They may help ease any soreness
and stickiness in your eyes. Always follow the manufacturer’s instructions.
Gently clean away sticky discharge from your eyelids and lashes using cotton
wool soaked in water.
Wash your hands regularly. This is particularly important after you have
touched your infected eyes and will stop the infection spreading to other people.
Antibiotics:-
Antibiotics are not usually prescribed for infective conjunctivitis as it
usually clears up by itself and there is a very low risk of complications for
untreated conjunctivitis. However, if the infection is particularly severe or it has
lasted for more than two weeks, you may be prescribed antibiotics. Some
schools or playgroups may insist that a child is treated with antibiotics before
they can return, although this is rarely necessary.
The two main types of antibiotics that may be prescribed are:
1. Chloramphenicol
2. Fusidic Acid
Chloramphenicol :- Chloramphenicol is usually the first choice and comes in the
form of eye drops. Make sure you follow your doctor's advice about how and
when to use the eye drops, or check the instructions that come with the

10. 9
medication so you know how to use them properly. If eye drops are not suitable
for you, you may be prescribed the antibiotic as an eye ointment instead.
Fusidic acid :- Fusidic acid may be prescribed if chloramphenicol is not suitable
for you. It's often better for children and elderly people as it doesn't need to be
used asoften. It is also the preferred treatment for pregnant women. Like
chloramphenicol, fusidic acid comes in the form of eye drops and should be
used as advised by your doctoror as described in the instructions that come with
the medication.
Side effects:-
Eye drops can briefly cause blurred vision. Avoid driving or operating
machinery straight after using eye drops. Chloramphenicol and fusidic acid can
also cause some other side effects, such as a slight stinging or burning sensation
in your eye. This feeling should not last long.
Further treatment
If you still have symptoms after two weeks, it is very important to go
back to any GP. Also contact your GP immediately if experience any of the
symptoms.
Allergic conjunctivitis
The treatment will depend on which type of allergic conjunctivitis have.The
four main types of allergic conjunctivitis are:
 Seasonal conjunctivitis: typically caused by an allergy to pollen
 Perennial conjunctivitis: usually caused by an allergy dust mites or pets
 Contact dermatoconjunctivitis: usually caused by an allergy to eye
drops or cosmetics
 Giant papillary conjunctivitis: usually caused by an allergy to contact
lenses
Whatever the cause, you will find that some selfhelp methods can ease your
symptoms.
If you have allergic conjunctivitis, you can follow the guidelines below to
treat your condition at home:
 Remove your contact lenses. If you wear contact lenses, take them out
until all the signs and symptoms of the conjunctivitis have gone.
 Do not rub your eyes, even though your eyes may be itchy. Rubbing them
can make your symptoms worse.
 Place a cool compress over your eyes.
 Wetting a flannel with cool water and holding it over your eyes will help
ease your symptoms.
 Avoid exposure to the allergen, if possible.
Seasonal and perennial allergic conjunctivitis:-

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If you have seasonal or perennial conjunctivitis you may be prescribed the
following medicines:
 Antihistamines
 Mast cell stabilisers
 Corticosteroids
These are described in more detail below.
Antihistamines:- If your allergic conjunctivitis requires rapid relief, your GP will
probably prescribe a medicine known as an antihistamine. Antihistamines work
by blocking the action of the chemical histamine, which the body releases when
it thinks it is under attack from an allergen. This prevents the symptoms of the
allergic reaction from occurring.
Antihistamine eye drops
 Azelastine (not suitable for children under four years of age)
 Emedastine (not suitable for children under three years of age)
 Ketotifen (not suitable for children under three years of age)
 Antazoline with xylometazoline (otrivine antistin, not suitable for
children under 12 years of age)
 Antazoline with xylometazoline (otrivine antistin) is also available over
the counter from pharmacies without prescription.
Always follow the manufacturer’s instructions. If you are pregnant or
breastfeeding, some antihistamine eye drops may not be suitable. Speak to your
GP for advice.
Oral antihistamines
You will usually only have to take an antihistamine once a day. If
possible, oral antihistamines should not be taken if you are pregnant or
breastfeeding. Speak to your GP for advice.
Although new antihistamines should not make you drowsy, they may still have
a sedating effect. This is more likely if you take high doses or drink alcohol
while you are taking antihistamines.
Mast cell stabilisers
Mast cell stabilisers are an alternative type of medicine. Unlike
antihistamines, they will not provide rapid relief from your symptoms, but they
are more effective at controlling your symptoms over a longer period of time.
It may take several weeks to feel the effects so you may also be prescribed an
antihistamine to take at the same time.
Mast cell stabilisers that are commonly prescribed in the form of eye drops
include:
 Lodoxamide
 Nedocromil sodium

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 Sodium cromoglicate
Corticosteroids
If your symptoms of allergic conjunctivitis are particularly severe, you may be
prescribed a short course of topical corticosteroids (a cream, gel or ointment).
However, these are not usually prescribed unless absolutely necessary.
Ayurvedic Remedies
 The root of the Berberis asiatica (Daaru haldi) is very efficacious in
conjunctivitis. Make decoction by boiling two parts by weight of the root in
26 parts of water until the quantity is reduced to about three parts. Use it as
an eye-ointment (collyrium) by mixing with honey.
 The decoction of turmeric is a very cooling application in conjunctivitis; you
can either wash your eyes with this decoction or apply the compress made
with decoction over the eyes.
 Trifala lotion is made by soaking 15 gm of Triphala choorna in 200 ml of
water for half an hour, boiling and filtering it. This is used for washing the
affected eyes 3-4 times a day.
 Trifala churna orally about 5 gm with water is useful for viral infections.
 The freshly extracted juice of amla in the dose of 2 teaspoonfuls thrice a day
is rewarding.
 If these self-help measures do not help, your doctor may prescribe Netrabingu
and such eye drops for you. These lubricating eye drops can wash out your
eyes, make the swelling go down, soothe irritation, and help relieve itching.
 If these medicines do not give you enough relief, your doctor may suggest
desensitisation therapy; your allergic reaction is reduced or stopped when you

13. 12
take small doses of the allergen. The small doses are slowly increased. This is
one way to control long-term (chronic) allergic conjunctivitis. This concept is
termed as okasaatmya in Ayurveda. For this purpose, the medicines like
Chandrodaya varti are used externally.
 Seek medical help if you have severe eye pain, eye sensitivity to the light, pus
like discharge that is yellowish-green in colour, and persisting symptoms or
worsened symptoms irrespective of self-care measures after 24 hours.
There are three main types of conjunctivitis that are commonly seen:
1. Allergic Conjunctivitis
2. Bacterial Conjunctivitis
3. Viral Conjunctivitis
CAUSES AND SYMPTOMS AS PER AYURVEDA
The most common cause for this is the exposure of the eyes to dust,
smoke, cold winds etc. There are many allergens which may also lead to
conjunctivitis. Eye cosmetics, contact lenses, mascara, facial powders are few
such allergenic substances which may cause conjunctivitis.
The common symptoms of conjunctivitis are given below:
 The eyes become red and
are accompanied by
itchiness. Water also
discharges from the eyes.
 Sometimes there is
inflammation of the inner
eyelids and the eyes also
pain.
 There is a sticky discharge
from the eyes which seals
the lids together.
 The eyes also become extremely sensitive to light and it is difficult to
keep the eyes open for long durations
Depending upon the type of conjunctivitis, the symptoms vary which is shown
below:
Type of
Conjunctivitis
Symptoms

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Allergic
Conjunctivitis
 Severely itchy and the eyelids become swelled.
 There may be no redness in the eye
Bacterial
Conjunctivitis
 Sticky discharge from the eyes which makes them stick
together every morning
 A gritty or sandy feeling in the eye
Viral Conjunctivitis  Watery discharge from the eyes
 Itchy sensation in one or both the eyes
AYURVEDIC MEDICINES AND PRESCRIPTIONS
The following ayurvedic preparations have good benefits during conjunctivitis.
1. NETRASHNI RASA – 200 ml of netrashni rasa should be taken with hot
water two times daily.
2. MAHATRIPHALADI
GHRITA – 10 gm should
be taken three times in a
day after meals.
3. CHANDRODAYA
VATI – It should be taken
twice in a day to
desensitize to allergies.
4. TRIPHALA CHURNA –
5 gm of triphala churna should be taken orally with warm water twice
daily and its lotion should also be used as an eye wash.
5. RASANJANADI RASAKRIYA – It should be used as collyrium in case
of chronic conjunctivitis.
Apart from the above mentioned ayurvedic medicines there are some herbs
which have been found useful in reducing the symptoms of conjunctivitis.
Ayurvedic
Name
Common
English
Name
Benefits
Neem Margosa A paste is made of neem leaves and applied externally onto
the eyes. This is useful in reducing the pain during
conjunctivitis.
Chirchita Rough Chaff The roots of the chirchita are used to make a paste which
when applied on the eyes reduces the pain and inflammation
of conjunctivitis.

15. 14
Prajmoda Parsley The juice of raw parsley is very beneficial for conjunctivitis
when applied externally on the eye.
Hara
Dhania
Coriander A freshly prepared extract of coriander in water is used to
wash eyes. It relieves the burning of the eyes and reduces
pain and swelling.
Chandi East Indian
Rosebay
The juice of the chandi tree reduces inflammation and
provides a soothing effect on the eye.
Tarwar Tenner’s
Cassia
Fine powder made of tarwar seeds is used for dusting over
the eyes which give great relief in conjunctivitis.
OTHER NATURAL REMEDIES PRESCRIBED BY AYURVEDA
The eyes should be kept clean and washed after returning from outdoors.
Towels, pillows, combs etc. should not be shared.
 Eyes should not be rubbed or wiped with hands. Goggles should be used
to prevent the infection from spreading to others.
 Water with borax dissolved in it should be used as an eye wash. This
helps to keep the eyes clean and also gives relief.
 A paste made of 4 gm each of large harada, roasted alum and 1 gm of
opium with little water should be applied over the eyelids.
 A very good remedy is to take amla juice with a little honey.
 100 ml of rose water, 2 gm each of rock salt, candid sugar, alum and 5
gm of rasaut should be mixed and used as an eye drop.
DIET AND OTHER REGIMEN
 Hot, oily, spicy and hard to digest foods should be avoided as they may
worsen the condition by producing more inflammation. Sour substances
should also be avoided.

16. 15
 Fresh fruits and green leafy vegetables should be increased as these have
a cooling effect on the body.
 A mild laxative may be given to get rid of constipation.
COST OF TREATMENT
For patients covered by health insurance, out-of-pocket costs typically consist
of doctor visit copays, prescription drug copays or coinsurance of 10%-50%.
Treatment for pink eye typically is covered by insurance.
For patients not covered by health insurance, treatment for pink eye can cost
from 300 to almost 2000 or more for an initial doctor visit. Treatment can cost
less than 300 for cold compresses and artificial tears for viral pink eye. It can
cost from less than 250-1200 or more for antibiotic eye drops for bacterial pink
eye. And it can cost from less than 150 to 1300 or more for antihistamine eye
drops for allergy-related pink eye, and up to almost 4,000 for the first year, then
up to 2,000 or more per year, for allergy shots.
A doctor visit for pink eye costs about 950 at urgent care or up to 1900 or more
at an emergency room, according to Wellmark Blue Cross and Blue Shield
mutual insurance company. Eastern Maine Medical Center charges 300 for a
visit for pink eye, while Physicians Urgent Care in Tennessee charges about $65
and The Little Clinic[3] urgent care center, with locations in six states including
Arizona, Colorado, and Ohio, charges 1200, plus possibly an additional $23
pink eye lab test fee.
For treatment, Drugstore.com charges about 600-1200 for preservative-free
artificial tears. And Drugstore.com charges 180-900 for cold compresses.
Drugstore.com charges about 300 for a bottle of generic sulfacetamide sodium
antibiotic drops. It charges about 350 for a bottle of generic tobramycin sulfate
antibiotic drops, and about 4000 for the brand-name equivalent, Tobrex . It
charges about 360-700, depending on dose, for a bottle of generic tobramycin-
dexamethasone, a combination antibiotic-corticosteroid eye drop, and 650-7000
for the brand-name equivalent, TobraDex.
Drugstore.com charges about 500 for a bottle of Zaditor over-the-counter
antihistamine eye drops. It charges about 350 per bottle for generic cromolyn
sodium prescription antihistamine eye drops. It charges about $130 per bottle
for Patanol prescription brand-name antihistamine eye drops. Or, allergy shots

17. 16
cost about 1,500-3,900 for the first year, then 720 to 1,800 per year in
subsequent years.
Suggestion
 Do not touch the eye area with your fingers. If you wish to wipe your eyes,
use tissues or clean and fresh handkerchief.
 Avoid rubbing your eyes.
 With your eyes closed, apply a washcloth soaked in warm (not hot) water to
the affected eye three to four times a day for at least five minutes at a time.
(These soaks also help to dissolve the crusty residue of pinkeye).
 Alternately, you can also put a cold compress over your eyes for relief (use a
wash-cloth or small towel soaked in cold water or wrapped around ice cubes.)
 Avoid wearing eye makeup until the infection has completely cleared up.
(And never share makeup items and spectacles with others.)
 Do not cover or patch the eye. This can make the infection grow.
 Do not wear contact lenses while your eyes are infected.
 Wash your hands often and use your own towels. Pink eye is very contagious
and can be spread from one person to another by contaminated fingers,
washcloths, or towels. Clean all of the personal items daily with soap and
water.
 Do not touch the infected eye cause the infection will spread to the good eye.
 If you can identify the cause of allergic conjunctivitis, it may be possible to
prevent its occurrence. Anyhow, avoid airborne pollens, dust, mould spore
and animal dander, or direct contact with chlorinated water or cosmetics.
 Wear clothes only once before washing.

18. 17
 Changes pillowcase each night.
INTRODUCTION
Hyperthyroidism
Hyperthyroidism, often called overactive thyroid and sometimes
hyperthyreosis, is a condition in which the thyroid gland produces and secretes
excessive amounts of the free (not protein bound circulating in the blood)
thyroid hormones triiodothyronine (T3) and/or thyroxine (T4). Graves' disease
is the most common cause of hyperthyroidism. The opposite is hypothyroidism
('sluggish thyroid'),which is reduced production and secretion of T3 and/or T4.
Hyperthyroidism is one cause of thyrotoxicosis—the hypermetabolic
clinical syndrome which occurs when there are elevated serum levels of T3
and/or T4. Thyrotoxicosis can also occur without hyperthyroidism. Some
people develop thyrotoxicosis due to inflammation of the thyroid gland
(thyroiditis), which can lead to excessive release of thyroid hormone already
stored in the gland (without the accelerated hormone production that
characterizes hyperthyroidism).
Thyrotoxicosis can also occur after taking too much thyroid hormone in
the form of supplements, such as levothyroxine (a phenomenon known as
exogenous thyrotoxicosis, alimentary thyrotoxicosis, or occult factitial
thyrotoxicosis). Thyroid imaging and radiotracer thyroid uptake measurements,
combined with serologic data, enable specific diagnosis and appropriate
treatment.
Management differ for
thyrotoxicosis caused by
hyperthyroidism and
thyrotoxicosis caused by other
conditions. This often includes:
initial temporary use of
suppressive thyrostatics
medication (antithyroid drugs),

19. 18
and possibly later use of permanent surgical or radioisotope therapy. All
approaches may cause underactive thyroid function (hypothyroidism) which is
easily managed with levothyroxine or triiodothyronine supplementation.
Surgery as an option predates the use of the less invasive radioisotope therapy
(radioiodine 131 thyroid ablation), but is still required in cases where the
thyroid gland is enlarged and causing compression to the neck structures, or the
underlying cause of the hyperthyroidism may be cancerous in origin.
Causes
There are several causes of hyperthyroidism. Most often, the entire gland
is overproducing thyroid hormone. Less commonly, a single nodule is
responsible for the excess hormone secretion, called a "hot" nodule. Thyroiditis
(inflammation of the thyroid) can also cause hyperthyroidism. Functional
thyroid tissue producing an excess of thyroid hormone occurs in a number of
clinical conditions.
The major causes in humans are:
 Graves' disease: An autoimmune disease (usually, the most common
etiology with 5080% worldwide, although this varies substantially with
locationi 47% in Switzerland (Horst 1987) to 90% in the USA
(Hamburger 1981)). Thought to be due to varying levels of iodine in the
diet.
 Toxic thyroid adenoma (the most common etiology in Switzerland, 53%,
thought to be atypical due to a low level of dietary iodine in this country).
 Toxic multinodular goitre.
High blood levels of thyroid hormones (most accurately termed
hyperthyroxinemia) can occur for a number of other reasons:
 Inflammation of the thyroid is called thyroiditis. There are several
different kinds of thyroiditis including Hashimoto's thyroiditis
(Hypothyroidism immunemediated), and subacute thyroiditis
(DeQuervain's). These may be initially associated with secretion of
excess thyroid hormone, but usually progress to gland dysfunction and,
thus, to hormone deficiency and hypothyroidism.
 Amiodarone, an antiarrhythmic drug, is structurally similar to thyroxine
and may cause either under or over activity of the thyroid.
 Postpartum thyroiditis (PPT) occurs in about 7% of women during the
year after they give birth.

20. 19
 PPT typically has several phases, the first of which is hyperthyroidism.
This form of hyperthyroidism usually corrects itself within weeks or
months without the need for treatment.
 A struma ovarii is a rare form of monodermal teratoma that contains
mostly thyroid tissue, which leads to hyperthyroidism. Excess iodine
consumption notably from algae such as Kelp.
Hypersecretion of thyroid stimulating hormone (TSH), which in turn is almost
always caused by apituitary adenoma, accounts for much less than 1 percent of
hyperthyroidism cases.
Symptoms
If there is too much thyroid hormone, every function of the body tends to
speed up. Therefore, some of the symptoms of hyperthyroidism may be
nervousness, irritability, increased perspiration, heart racing, hand tremors,
anxiety, difficulty sleeping, thinning of the skin, fine brittle hair, and muscular
weakness especially in the upper arms and thighs. More frequent bowel
movements may occur, but diarrhoea is uncommon. Weight loss, sometimes
significant, may occur despite a good appetite (though 10% of people with a
hyperactive thyroid weight gain), vomiting may occur, and, for women,
menstrual flow may lighten and menstrual periods may occur less often.
Thyroid hormone is critical to normal function of cells. In excess, it both
over stimulates metabolism and exacerbates the effect of the sympathetic
nervous system, causing "speeding up" of various body systems and symptoms
resembling an overdose of epinephrine (adrenaline). These include fast heart
beat and symptoms of palpitations, nervous system tremor such as of the hands
and anxiety symptoms, digestive system hypermotility, unintended weight loss,
and (in "lipid panel" blood tests) lower and sometimes unusually low serum
cholesterol.
In Graves' disease, which is the most common form or cause of
hyperthyroidism, the eyes may look enlarged because the eye muscles swell and
push the eye forward. This can only be resolved surgicallyby orbital
decompression. Sometimes, one or both eyes may bulge. Some patients have
swelling of the front of the neck from an enlarged thyroid gland (a goitre).
Because hyperthyroidism, especially Graves’ disease, may run in families,
examinations of the members of a family may reveal other individuals with
thyroid problems.
Minor ocular (eye) signs, which may be present in any type of hyperthyroidism,
are eyelid retraction ("stare"), extraocular muscle weakness, and lidlag.
In hyperthyroid stare (Dalrymple sign) the eyelids are retracted upward
more than normal (the normal position is at the superior corneoscleral limbus,

21. 20
where the "white" of the eye begins at the upper border of the iris). Extraocular
muscle weakness may present with double vision. In lidlag (von Graefe's sign),
when the patient tracks an object downward with their eyes, the eyelid fails to
follow the downward moving iris, and the same type of upper globe exposure
which is seen with lid retraction occurs, temporarily. These signs disappear with
treatment of the hyperthyroidism.
Neither of these ocular signs should be confused with exophthalmos
(protrusion of the eyeball), which occurs specifically and uniquely in
hyperthyroidism caused by Graves' disease (note that not all exophthalmos is
caused by Graves' disease, but when present with hyperthyroidism is diagnostic
of Graves' disease). This forward protrusion of the eyes is due to immune
mediated inflammation in the retro orbital (eye socket) fat. Exophthalmos, when
present, may exacerbate hyperthyroid lid lag and stare.
Thyroid storm
"Thyroid storm" is a severe form of thyrotoxicosis characterized by rapid
and often irregular heart beat, high temperature, vomiting, diarrhea, and mental
agitation. It is a medical emergency and requires hospital care to rapidly control
the symptoms, as it carries a substantial mortality.
Hypothyroidism

22. 21
Hyperthyroidism due to certain types of thyroiditis can eventually lead to
hypothyroidism (a lack of thyroid hormone), as the thyroid gland is damaged.
Also, radioiodine treatment of Graves' disease often eventually leads to
hypothyroidism. Such hypothyroidism may be treated by regular thyroid
hormone testing and oral thyroid hormone supplementation.
Some common signs and symptoms of hyperthyroidism include:
 Unintended weight loss (even when your appetite and diet are normal or in
some cases, may be more than normal)
 Rapid heartbeat (tachycardia) : the heart rate may be more than 100 beats a
minute (in healthy adults, the heart rate is about 70 beats a minute)
 Irregular heartbeat (arrhythmia) or feeling of pounding of heart (palpitations)
 Increase in appetite (but even after increase in appetite, you may lose weight)
 Nervousness, anxiety and
irritability
 Tremor (fine trembling in your
hands and fingers that
increases when the hands are
stretched)
 Sweating and feeling
excessively hot (increase in
sensitivity to heat)
 Changes in menstrual patterns
(in women)
 Changes in bowel patterns, (it
may become more frequent
and may be loose)
 Enlargement of thyroid gland (goitre), which may appear as a swelling at the
base of your neck and move with swallowing,
 Fatigue, weakness and tiredness.

23. 22
 Difficulty in sleeping (even though you feel tired and exhausted).
Signs and symptoms may not be very evident in older adults. Older adults are
more likely to have either no signs or symptoms that are subtle such as an
increased heart rate, heat intolerance and a tendency to get tired after doing
ordinary activities.
TREATMENT
Antithyroid drugs :-
Thyrostatics (antithyroid drugs) are drugs that inhibit the production of
thyroid hormones, such as carbimazole (used in UK) and methimazole (used in
US), and propylthiouracil. Thyrostatics are believed to work by inhibiting the
iodination of thyroglobulin by thyroperoxidase, and, thus, the formation of
tetraiodothyronine (T4). Propylthiouracil also works outside the thyroid gland,
preventing conversion of (mostly inactive) T4 to the active form T3. Because
thyroid tissue usually contains a substantial reserve of thyroid hormone,
thyrostatics can take weeks to become effective, and the dose often needs to be
carefully titrated over a period of months, with regular doctor visits and blood
tests to monitor results.
A very high dose is often needed early in treatment, but, if too high a
dose is used persistently, patients can develop symptoms of hypothyroidism.
This titrating of the dose is difficult to do accurately, and so sometimes a "block
and replace" attitude is taken. In block and replace treatments thyrostatics are
taken in sufficient quantities to completely block thyroid hormones, and the
patient treated as though they have complete hypothyroidism.
Betablockers :-
Many of the common symptoms of hyperthyroidism such as palpitations,
trembling, and anxiety are mediated by increases in beta adrenergic receptors on
cell surfaces. Beta blockers, typically used to treathigh blood pressure, are a
class of drugs that offset this effect, reducing rapid pulse associated with the
sensation of palpitations, and decreasing tremor and anxiety. Thus, a patient
suffering from hyperthyroidism can often obtain immediate temporary relief
until the hyperthyroidism can be characterized with the Radioiodine test noted
above and more permanent treatment take place. Note that these drugs do not
treat hyperthyroidism or any of its long term effects if left untreated, but, rather,
they treat or reduce only symptoms of the condition. Some minimal effect on
thyroid hormone production however also comes with Propranolol which has
two roles in the treatment of hyperthyroidism, determined by the different
isomers of propranolol. Lpropranolol causes beta blockade, thus treating the

24. 23
symptoms associated with hyperthyroidism such as tremor, palpitations,
anxiety, and heat intolerance.
Dpropranolol inhibits Thyroxine deiodinase, thereby blocking the
conversion of T4 to T3, providing some though minimal therapeutic effect.
Other beta blockers are used to treat only the symptoms associated with
hyperthyroidism.[20] Propranolol in the UK, and Metoprolol in the US, are
most frequently used to augment treatment for hyperthyroid patients.
Food and diet :-
Patients cannot have foods high in iodine, such as edible seaweed and
kelps. From a public health perspective, the general introduction of iodised salt
in the United States in 1924 resulted in lower disease, goiters, as well as
improving the lives of children whose mothers wouldn't have eaten enough
iodine during pregnancy which would have lowered the IQs of their children.
Surgery :-
Surgery (thyroidectomy to remove the whole thyroid or a part of it) is not
extensively used because most common forms of hyperthyroidism are quite
effectively treated by the radioactive iodine method, and because there is a risk
of also removing the parathyroid glands, and of cutting the recurrent laryngeal
nerve, making swallowing difficult, and even simply generalized staphylococcal
infection as with any major surgery. Some people with Graves' may opt for
surgical intervention. This includes those that cannot tolerate medicines for one
reason or another, people that are allergic to iodine, or people that refuse
radioiodine.
If people have toxic nodules treatments typically include either removal
or injection of the nodule with alcohol.

25. 24
Radioiodine :-
In iodine131V(radioiodine) radioisotope therapy, which was first pioneered by
Dr. Saul Hertz, radioactive iodine131 is given orally (either by pill or liquid) on
a onetime basis, to severely restrict, or altogether destroy the function of a
hyperactive thyroid gland. This isotope of radioactive iodine used for ablative
treatment is more potent than diagnostic radioiodine (usually iodine123 or a
very low amount of iodine131), which has a biological half life from 8–13
hours. Iodine131, which also emits beta particles that are far more damaging to
tissues at short range, has a halflife of approximately 8 days.
Most patients do not experience any difficulty after the radioactive iodine
treatment, usually given as a small pill. On occasion, neck tenderness or a sore
throat may become apparent after a few days, if moderate inflammation in the
thyroid develops and produces discomfort in the neck or throat area. This is
usually transient, and not associated with a fever, etc.
Women breastfeeding should discontinue breastfeeding for at least a
week, and likely longer, following radioactive iodine treatment, as small
amounts of radioactive iodine may be found in breast milk even several weeks
after the radioactive iodine treatment.
A common outcome following radioiodine is a swing from
hyperthyroidism to the easily treatable hypothyroidism, which occurs in 78% of
those treated for Graves' thyrotoxicosis and in 40% of those with toxic
multinodular goitre or solitary toxic adenoma. Use of higher doses of
radioiodine reduces the incidence of treatment failure, with penalty for higher
response to treatment consisting mostly of higher rates of eventual
hypothyroidism which requires hormone treatment for life.

26. 25
There is increased sensitivity to radioiodine therapy in thyroids appearing
on ultrasound scans as more uniform (hypoechogenic), due to densely packed
large cells, with 81% later becoming hypothyroid, compared to just 37% in
those with more normal scan appearances (normoechogenic).
Ayurvedic Remedies
 Kamdudha Ras, PravalPanchamrut, PravalBhasma, ChandrakalaRas and
SutshekharRas are administered to relieve excessive sweating and heat
intolerance.
 Kutaj-Parpati, PanchamrutParpati and BilvaAvelaha are used to ease
increased bowel movements caused by hyperthyroidism.
 Fatigue can be cured with Makardhwaj, SuvarnaMaliniVasant,
KharjurManth, Drakshasav and Lohasav.
 YograjGuggulu, BoladiVati, Kumaryasav and GandharvaHaritaki are used to
normalise irregular menstrual cycles and their flow.
 Nervousness, tremor and agitation are corrected with the help of usinh
Brahmi, Jatamansi, Shankhpushpi, Sarpagandha, Saraswatarishta and
Dashmoolarishta.
Medicines used to treat Grave’s Disease or inflammation of the
Thyroid Gland :- Arogya Vardhini, Panch Tikta Ghrut Guggulu, Triphala
Guggulu, Punarnavadi Guggulu, Maha Manjishthadi Qadha, Amalaki (Emblica
officinalis), Haritaki (Terminalia chebula), Behada (Terminalia bellerica),
Kanchnaar (Bauhinia variegata), Saariva (Hemidesmus indicus), Usheer
(Vetiveria zizanioidis), Chandan (Santalum album), Nimba (Azadirachta
indica), Guduchi (Tinospora cordifolia) and Gokshur (Tribulus terrestris).
Additional Medicines :- For early recovery, additional medicines are added
to the already prescribed doses to treat hyperthyroidism. Additional medicines
include Suvarna Sutshekhar Ras, Suvarna Sameerpannag and Abhrak Bhasma.
Since Grave's disease is an autoimmune disorder, medications, such as
Ashwagandha (Withania somnifera), Shatavari (Asparagus racemosus), Tulsi

27. 26
(Ocimum sanctum), Bala (Sida cordifolia) and Naagbala (Grewia hirsuta) are
given to improve one’s immunity.
Home Remedies to treat Hyperthyroidism :- Have lots of cruciferous
vegetables, such as cabbages, kale, mustard greens and Brussels sprouts to
lower the chances of hyperthyroidism. These veggies can reduce the over
activity of the thyroid gland. Fruits, such as pears and peaches can prevent the
worsening of hyperthyroidism. Alcohol, caffeine and nicotine aggravate a
patient’s condition with hyperthyroidism, thus should be avoided. Progression
of this ailment can be
mitigated with a well-
balanced diet. Take
foods rich in iodine
along with protein
supplements.
Hypothyroidism is
treated by administering
anti-thyroid drugs,
ablation of the thyroid
gland with radioactive iodine, or by surgically removing a part or whole of the
thyroid. The Ayurvedic lifestyle can help to maintain the prescribed dosage,
prevent surgery and provides relief from symptoms, helping patients lead a near
normal life.
Include Goitrogenic Foods: Eat lots of goitrogenic foods. These foods
naturaly suppress the thyroid gland thus reducing hormone production. Include
cabbage, cauliflower, broccoli, turnips, Brussels sprouts, mustard greens,
kale, spinach and radishes in your diet. Eat millets, pears, peaches and soy.
These foods are best eaten raw.

28. 27
It is advisable to take these foods in limited quantity to avoid hypothyroidism
(deficiency of thyroid hormone).
Foods to Avoid: Avoid foods high in iodine. Reduce the intake of iodized salt
substantially. Avoid fish-sea fish and fresh water, sea vegetables, sea salts, sea
foods, red meat, milk and dairy products, wheat, oats, rye, barley, refined flour,
white bread, pasta, sugar, caffeine, nicotine and alcohol.
Avoid eating sea vegetables like kelp, kombu, Irish moss, nori, dulse and arame.
Go Natural: Avoid all kinds of processed and unnatural foods. Switch to organic
foods, fruits, vegetables and meat. Avoid commercially cooked foods like fried
snacks, packed chips, salted butter, margarine, etc.
Also look out for foods that may contain toxic materials or could cause an
allergy. Eliminate trans fats and switch to olive or vegetable oil for cooking.
Anti-inflammatory Action: Increase consumption of natural anti-inflammatory
foods such as turmeric, oregano, ginger, rosemary, coconut and coconut
products, berries and cinnamon. Use
ice packs in the inflamed area to get
relief.
Calcium and Vitamin D: Ask your
doctor for a calcium supplement.
Soak in morning sun to get your daily
dose of vitamin D to strengthen the
bones and immune system.
Herbal Remedies: According to Ayurveda, hyperthyroid is caused by an
aggravated pitta dosha. Hence, Ayurvedic treatment of the condition is centered
around pacifying the pitta. Herbs used in treating hyperthyroid are Guggul,
Black Cohosh, Shilajit, Brahmi, Gokshura, Alor vera. Lemon Balm from the
mint family, Dandelion and Red Clover.
Yoga Therapy: Meditation, Pranayama and Yogasanas play a vital role in
maintaining thyroid health and in reducing the symptoms arising out of
hyperthyroid. Chanting of 'Hari Om' while meditating, Sheetali, Sheetkari, Nadi
Shodhan, Bhramari, and Ujjayi Pranayam, and practice of asanas like

29. 28
Suryanamaskar at slow pace, Shishuasana, Marjariasana, Setubandhasana, and
Shavasana will be beneficial.
By adopting a healthy lifestyle and taking due cognizance in selection of food, a
person suffering from Hyperthyroid can lead a normal life. It is advisable to get
regular tests done to ensure that TSH, T3 and T4 levels are in control.
COST OF TREATMENT
For patients covered by health insurance, the typical cost of hyperthyroidism
treatment will include doctor copays and prescription drug copays.
Hyperthyroidism treatment typically is covered by health insurance.
For patients not covered by health insurance, the typical cost of hyperthyroid
treatment is 100-1500 a month -- or 1200-18,000 a year -- for drugs, or up to
4,000 or more for a radioactive iodine treatment or up to 25,000 or more for
surgery. For example, a one-month supply of the generic anti-thyroid drug
methimazole costs about 300-900 depending on the dose or, about 3600-14,500
a year. And a one-month supply of the brand-name drug Tapazole costs about
500-1500 or more, depending on the dose or, about 6000-18,000 per year.
Once the hyperthyroidism is under control, the dose typically can be lowered to
a maintenance dose, which typically would cost 100-500 a month (1200-6000 a
year) for the generic drug or 300-900 a month (3600-10800 a year) for the
brand-name drug. A radioactive iodine treatment costs about 900 to 7500 for an
average dose, according to a February 2011 article published in the New
England Journal of Medicine, but patients at ThyroidBoard.com report total
costs of 4,000 or more, including hospital and radiologist fees. And, at Saint
Elizabeth Regional Medical Center in Nebraska, a thyroidectomy -- surgery to
remove the thyroid -- costs from just under 30,000 to more than 50,000, not

30. 29
including the doctor fees. Doctor fees can add thousands of rupees to the total
cost.
Bibliography
Conjunctivitis
http://en.wikipedia.org/wiki/Conjunctivitis
http://www.homeveda.com/eyes/natural-ayurvedic-home-remedies-for-
conjunctivitis-pink-eye.html
http://www.bupa.co.uk/health-information/directory/c/conjunctivitis
http://www.webmd.boots.com/eye-health/guide/conjunctivitis
http://www.allaboutvision.com/conditions/conjunctivitis.htm
http://www.muralimanohar.com/Articles,%20English/Diseases%20and%20Con
ditions/Conjunctivitis.htm
Hyperthyroidism
http://en.wikipedia.org/wiki/Hyperthyroidism
http://mywellness.in/hyperthyroid-causes-symptoms-and-natural-remedies/
http://www.medindia.net/drugs/medical-condition/hyperthyroidism.htm
http://www.healthline.com/health/hyperthyroidism

31. 30
http://www.webmd.com/women/overactive-thyroid-hyperthyroidism
http://www.emedicinehealth.com/hyperthyroidism/article_em.htm
SELF REALIZATION
I feel very energetic when I searching information for the
disease like Conjunctivitis and Hyperthyroidism in the internet.
Its help us to develop our get improve my knowledge about
disease. Its teach us to keep healthy and secure prevent and
awareness. How an Ayurveda get solution for the big disease
like Conjunctivitis and Hyperthyroidism. Although the disease
was common but danger to health .This assignment teaches us
how to be healthy and prevent from this disease.