Goiter

WESTERN MEDICINE: Goiter includes the simple goiter, endemic goiter, nontoxic nodular goiter. It is an enlargement of the thyroid gland resulting from iodine deficiency due to any cause. If the deficiency is caused by inadequate dietary intake of iodine, it is called endemic (colloid) goiter, Many drugs including aminosalicylic acid (PAS), sulfonylureas, and iodine in large doses, as well as naturally occuring goitrogens such as cabbage and kale, may block the synthesis of thyroid hormone and result in a goiter through stimulation of thyroid-stimulating hormone (TSH) by the hypothalamic-pituitary axis. Goiter is particularly apt to occur during puberty and pregnancy. Persistent stimulation and involution may result in non-toxic nodular goiters.

SYMPTOMS AND SIGNS: In the early stages, diagnosis depends on the presence of a soft, symmetrical smooth goiter. There may be a history of low iodine intake or ingestion of goitrogens. The uptake of a radio-iodine tracer may be normal or high, with a normal thyroid scan. The BMR, PSI, and radioiodinated triiodothyronine RSC or resin uptake (T3 uptake) are usually normal. Later, multiple nodules and cysts appear. It is called Yin Bin in Chinese medicine. 

ETIOLOGY AND PATHOLOGY: YinBin(goiter) has been recorded since 300 - 400 B.C. ago in Chinese medical books. It has been categorized into several kinds of Yin, such as Qi Yin, Rou Yin, Shi Yin, etc. Goiter mostly means Qi Yin in Chinese medicine. Chinese medicine considered that goiter is closely related with the environment, which indicates the lack of iodine in the water and earth. Another popular etiological factor is due to prolonged unhealthy emotions which can cause liver Qi stagnation, the latter can be combined with phlegm and other substantial pathogenic factor thereby creating the goiter.

DIFFERENTIATIONS:

1. The Qi Stagnant Type:

Indications: An enlarged thyroid gland, the size changes when emotions change, smaller in happy mood, larger in anger or other strong emotions, fullness or pain at chest or hypochondriac areas, extended feeling of breast before or during menstruation, or lower abdominal pain, thin tongue coating, wiry pulse. 

Treatment & Formulas: Regulate the stagnant Qi and harmonize the liver. 

Products:

    • Jia Wei Xiao Yao San (Bupleurum and Paeonia Formula, Item No. 2068) or
    • Xiao Yao San (Tang - kuei and Bupleurum Formula, Item No. 2195).
    • Both formulas may be added to Hai Dai (Laminaria Thallus, Kelp, Item No. 1157) and Hai Piao Xiao (Sepiae Os, Cuttlebone, Item No. 1159) to provide iodine and resolve the hardness. 

2. Damp - Phlegm Type:

Indications: Enlarged thyroid gland, accompanied with full and suffocating sensation of chest, cough with profuse sputum, white, thick and greasy tongue coating, slow and slippery pulse. 

Treatment & Formulas: Resolve damp-phlegm and soften the hardness. 

Products:

    • San Zhong Kuei Jien Tang (Forsythia and Laminaria Combination, Item No. 2221 ): This is a typical formula for goiter due to the combinations of Qi, blood, dampness and phlegm. It is also applied for scrofula, gland infections, tumors, and other hard inflammations.
    • Er Chen Tang (Citrus & Pinellia Combination, Item No. 2003): It can be combined with other formulas to strengthen the functions of eliminating the damp-phlegm. 

COMMENTS: Since goiter is caused by the deficiency of iodine, traditionally, Hai Dai (Laminaria Thallus, Kelp, Item No. 1157) can be used alone with its supply of iodine and also its function of resolving phlegm and hardness. It can be used as a daily tea drink to prevent or treat goiter. 


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