Abstract: Primary hypothyroidism or underactive hypothyroidism is a condition where the thyroid gland functions affected with elevation in thyroid stimulating hormone (TSH) >10 mU/L with free t4 level below the normal range exhibiting features like weight gain, dry skin, cold intolerance, depression etc. The prognosis of the disease has a wider impact on other system like respiratory, cardiac, gastrointestinal, metabolic, skin, renal and musculoskeletal systems exhibiting various clinical features. In Primary hypothyroidism with Obesity as per Ayurveda Samprapti, Aharaja, Viharaja, Manasika and Jatajanya nidana’s acts as a Moola karana in Vyadhi utpatti, causing Vruddi of Kapha, Vata Dosha’s and Kshaya of Pitta, leading to Agni vaishamyata (Jatharagni) further causing Rasa and Medho dhatvagni vyatyasa. In Modern science the clinical pathology is correlated to Gut brain thyroid axis disturbances linking to the disease manifestation. In present clinical study, the Chikitsa principle is Nidana parivarjana, Shamana by Krimighnadi Kashaya along with Shakotaka Taila for Pratimarsha Nasya, fuurther implementation of proper Dinacharya and Pathya Apathya which help in managing the Vyadhi by increasing Agni bala, balancing the tridosha, Rasa and Medo dhatu functions.