Hyperthyroidism

WESTERN MEDICINE: Hyperthyroidism includes thyrotoxicosis, toxic diffuse goiter, Graves disease; toxic nodular goiter, Plummer's disease. 

Toxic diffuse goiter (Graves' disease): A condition characterized by hyperplasia of the thyroid parenchyma, excessive secretion of its hormones increased metabolic rate, and exophthalmos. The cause is unknown, but a familial tendency is often seen. The disease may develop from emotional or physical stress. "Long acting thyroid stimulator" (LATS) has been found in the serum of patients with Graves' disease. It appears to be an antibody and may play a role in the etiology. 

Toxic nodular goiter: A condition characterized by excessive production of thyroid hormone by one or more autonomous nodules. It tends to occur in the older age groups and is often notable for a lack of clinical signs of thyrotoxicosis.

SYMPTOMS AND SIGNS: Hyperthyroidism is characterized by nervousness, weakness, sensitivity to heat, sweating, restless overactivity, weight loss (usually with increased appetite), tremor, palpitation, staring, lid lag, and exophthalmos. Occasionally headache, nausea, abdominal pain and diarrhea are prominent features. Older persons may have an apathetic form, with either heart failure or cachexia as outstanding findings. Occasionally patients with chronic heart failure are thyrotoxic, though the condition may pass unrecognized. The heart is overactive and may be enlarged. A high pulse pressure and systolic hypertension are frequent. Tachycardia or atrial fibrillation is common. The thyroid is usually diffusely enlarged in Grave's disease and often a bruise is present over it. Exophthalmos constitutes a problem in about 10% of patients with Graves's disease, sometimes accompanied by diplopia, chemosis, conjunctivitis, and infiltrative ophthalmopathy. Reddish nodules may be present on the anterior aspects of the legs and rarely clubbing of the fingers is present. In toxic nodular goiter the gland may not be enlarged but is nodular on palpation.

ETIOLOGY AND PATHOLOGY: The causative factor for hyperthyroidism is due to emotional and physical stress, which causes the liver Qi stagnation, gradually developed into liver fire, and heart Yin deficiency and damp-phlegm retentions. So the pathogenic factors of hyperthyroidism are stagnated Qi, phlegm and fire; but fundamentally it is due to the dysfunctions of heart, liver and kidney. 

DIFFERENTIATIONS: 

1. Liver Qi Stagnation Type:

Indications: Depression, or melancholy, distention or pain at hypochondriac regions, sighs often, or belching, poor appetite, or loose stool, 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): It is suitable for early onset or in light cases of  hyperthyroidism. For this period, the patient can only take this formula as medication. 

2. Flaming of Liver Fire Type:

Indications: Nervousness, sensitivity to heat, sweating, restless overactivity, insomnia, tremor, staring, flushed face, red tongue, thin and yellow coating, wiry and rapid pulse. 

Treatment & Formulas: Clear the liver fire and tonify the Yin or moisture. 

Products:

    • Long Dan Xie Gan Tang (Gentiana Combination Item No. 2267): This is a strong formula for sedating the liver. It also can be combined with Huan Lian Di Huang Tang (Coptls and Trichosanthes Combination, Item No. 2211) This tonifies the Yln and creates moisture to clear the interior heat. 
    • Dang Gui Liu Huang Tang (Tang-kuei and Six Yellow Combination, Item No. 2231): This is also a formula for patients with deficiency Yin and blood plus the hyperactivity of interior fire. 
    • Go Teng San (Gambir Formula, Item No. 2238): This is very good for liver Qi stagnation combined with phlegm and interior heat.
    • Yi Gan San (Bupleurum Formula, Item No. 2105): It harmonizes liver and clears the liver fire. So it is often used for nervousness, neurosis, irritability, insomnia, hysteria due to liver stagnated Qi with fire. 

3. Heart Yin Deficiency Type:

Indications: Insomnia, restlessness, palpitation, lassitude, profuse sweating, thirsty, nervous and fearful all the time, red tongue with thin coating, thready and rapid pulse. 

Treatment & Formulas: Tonify heart and tranquilize the spirit. 

Products:

    • Tian Wang Bu Xin Tang (Ginseng and Zizyphus Formula, Item No. 2055): This is a very good formula to tranquilize the spirit by tonifying the heart Yin and clearing the deficient fire. 
    • Lian Zhi Qing Xin Yin (Lotus Seed Combination, Item No. 2254): This is a very good tranquilizer by its function of Yin and Qi tonic, and also by its function of harmonizing the disturbed energy. 
    • Suan Zao Ren Tang (Zizyphus Combination, Item No. 2251 ): It tonifies the heart and kidney Yin so to tranquilize the disturbed spirit. It is very often applied for insomnia, night sweats, amnesia, etc. 

4. Damp - Phlegm Retention Type:

Indications: Enlarged thyroid gland, suffocating sensation at chest, nausea, vomiting, loose stool, poor or no appetite, or headache. Thin and greasy tongue coating, slow and slippery pulse.

Treatment & formula: Eliminate the damp - phlegm and resolve the hardness. 

Products:

    • San Zhong Kuei Jien Tang (Forsythia and Laminaria Combination, Item No. 2221): This is atypical formula to resolve and eliminate the damp - phlegm. It is often applied to all scrofula, gland infections, tumors, etc. 

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