Hashimoto’s thyroiditis, also known as chronic lymphocytic thyroiditis, is more common in middle-aged women. It is also a common cause of sporadic goiter in children. The onset is slow and insidious, and goiter is often found unintentionally, most of which are 2 to 8 times the normal thyroid gland. In the beginning, thyroid function was normal, sometimes accompanied by hyperthyroidism. But in the later stage, when the thyroid is destroyed to a certain extent, many patients gradually develop hypothyroidism. All middle-aged women with solid diffuse symmetrical goiters should suspect the disease regardless of their thyroid function status.
Currently, seven antibodies have been found in serums, including TGA, TMA, thyroid cell membrane, T3, T4, and TSI, some of which are involved in the destruction and pathogenesis of thyroid acinar. It is further clarified that cell-mediated immunity is involved in this disease and activated K cells can exert their cytotoxic effects and cause permanent damage to their thyroid cells. In addition, genetic predisposition and defects in immune monitoring may also be the basis for autoimmune reactions.
This disease is usually thought to be caused by innate genes’ combined influence and acquired environmental factors. Risk factors include a family history of this disease or other autoimmune diseases. The diagnosis method tests the value of thyroid-stimulating hormones (TSH), thyroid hormone (T4), and thyroglobulin antibody in the blood. The probability of women suffering from Hashimoto’s thyroiditis is about seven times greater than men. It can also occur in adolescents, but the most common incidence is in middle-aged people.
Serum TGA: 70% to 80% of patients are positive.
Serum TMA: More than 90% of patients are positive.
Potassium perchlorate excretion test: mostly positive.
T3, T4 decreased, and TSI increased.
Fine needle biopsy of the thyroid gland.
Diagnosis of Traditional Chinese Medicine(TCM) are:
1. Stagnation of liver qi:
Thin and swollen under the neck, tough, painless, and can be swallowed. In the early stages, there may be no typical symptoms, or only depression, irritability, heat fear, etc. Later, chest tightness, hyperhidrosis, and palpitations may be seen. Red tongue with a thin and yellow coat. The pulse is wiry.
Tx principles: Soothing the liver and regulating qi, removing phlegm, and dispelling congestion.
Formula: Chaihu Shugan Powder or Xiaoyao Powder.
Acupuncture points: TE6(Zhigou), LV3(Taichong), GB34(Yanglingquan), SP10(Xuehai), SP8(Diji). BL23(Shenshu), KI3(Taixi), SP6(Sanyinjiao).
2. Yin deficiency and internal heat:
Thin and swollen under the neck, severe and painless, nervousness, insomnia, hot flashes and night sweats, men’s nocturnal emission, women with low or amenorrhea, or piercing eyes, tremors of hands, palpitations, red tongue with fluid insufficiency, thready rapid pulse or string thready pulse. This type is rare.
Tx principles: Nourishes yin and clears away heat, softens, and clears knots.
Formula: Qiju Dihuang Tang addition and subtraction.
Acupuncture points: Gall swelling area, CV22(Tiantu), CV17(Hanzhong), LI4(Hegu), ST36(Zusanli), SP6(Sanyinjiao), SP40(Fenglong), BL18(Ganshu), LV3(Taichong), GB34(Yanglingquan).
Insufficiency of yin and fire increase in KI3(Taixi), KI7(Fuliu), and HT6(YinQi) relapse nourish yin and reduce the fire.
3. Deficiency of spleen and kidney yang:
Thin and swollen underneath the neck, pale complexion, cold limbs, sore waist and knees, dizziness, impotence in men, or less and cold, women with polychromatic menstruation, or amenorrhea, with The lower part is cold, or the expression is dull, and the face is puffy and swollen. The tongue is pale, the coating is white and slippery or greasy, and deep thready pulse or deep thin and weak pulse. This type is the most common.
Tx principles: Warm the spleen and kidney.
Formula: Jinkui Shenqi Wan.
Acupuncture points: ST36(Zusanli), ST42(Chongyang), CV4(Guanyuan), CV3(Zhongji), CV4(Qihai), SP6(Sanyinjiao), SP9(Yinlingquan), LI11(Quchi), LI4(Hegu), KI3(Taixi), KI2(Rangu), GB39(Xuanzhong), SP10(Xuehai). BL23(Shuitu), BL28(Pangguangshu).
4. Liver Qi and Phlegm Resistance:
Swollen neck lumps are painless, difficult in swallowing, irritable, chest oppression, sighing, rib-side pain oppression, sighing, rib-side pain, greasy tongue coat, and wiry pulse.
Tx principles: Soothing the liver and promoting blood circulation, dissipating phlegm, and mass.
Formula: Si Hai Shu Yu Wan.
Acupuncture points: GB20(Fengchi), BL23(Shenshu), KI3(Taixi), SP6(Sanyinjiao), ST10(Shuitu).
5. Phlegm coagulation stagnation:
Hard goiter like stone, large size painful lump, hoarse voice, thin-white-greasy coat, choppy-wiry pulse.
Tx principles: Invigorate blood and expectorant phlegm.
Formula: Hai Zao Yu Hu Tang.
Acupuncture points: ST36(Zusanli), SP6(Sanyinjiao), SP9(Yinlingquan), SP10(Xuehai), SP8(Diji), LV3(Taichong), PC6(Neiguan), ST41(Xiexi), GB39(Xuanzhong), BL60(Kunlun).