Abstract

NASAL DRUG DELIVERY AND NASYA IN THYROID DYSFUNCTION MANAGEMENT; A SYSTEMATIC REVIEW AND META-ANALYSIS OF CLINICAL EFFICACY, SAFETY, AND EVIDENCE QUALITY

Dr. Hemanta Gautam*, Dr. Achyut Acharya*, Prof. Shamsa Fiaz*

Abstract

Background: Subclinical hypothyroidism (SCH) affects 9.4- 20% of global populations, with conventional management remaining controversial.[1] Nasal drug delivery via Nasya (Ayurvedic nasal therapy) represents an innovative alternative leveraging direct nose-to-brain pathways for hypothalamicpituitary- thyroid (HPT) axis modulation.[2] Objective: To systematically evaluate the efficacy, safety, and evidence quality of nasal drug delivery systems, particularly Nasya therapy, in managing endocrinological disorders with emphasis on thyroid dysfunction and SCH.[3] Methods: We conducted a PRISMA 2020-compliant systematic review and metaanalysis.[ 4] Databases searched (inception-November 2025): MEDLINE, EMBASE, Cochrane CENTRAL, Scopus, and Ayurveda-specific databases. Included studies: RCTs, controlled trials, and cohort studies (n≥20, ≥8-week follow-up). Risk of bias assessed using RoB2 and Newcastle-Ottawa tools.[5] Random-effects meta-analysis performed; publication bias evaluated via funnel plots and Egger's test. Evidence quality assessed using GRADE framework.[6] Results: Study Selection: 2,927 records identified; 42 included in qualitative synthesis; 7 in meta-analysis (n=489 participants). Primary Outcome (TSH Reduction ≥20%): Nasya showed superior efficacy compared to oral therapy[7]: Pooled Risk Ratio: 2.37 (95% CI: 1.48-3.78, p

Keywords: systematic review, meta-analysis, nasya therapy, intranasal drug delivery, subclinical hypothyroidism, Ayurveda, HPT axis, GRADE methodology, evidence synthesis.