Clinical Observation On The Treatment Of Subacute Thyroiditis With Heat-clearing And Detoxification

purposeThrough the clinical observation of 68 cases of subacute thyroiditis,the efficacy of traditional Chinese medicine’s heat-clearing and detoxification method in the treatment of subacute thyroiditis was evaluated,and the data analysis of each index in the course of subacute thyroiditis was conducted to enrich the clinical research on subacute thyroiditis.methodsCollected in October 2017 to September 2018 in jiangsu province hospital endocrinology clinic included in the standard of a total of 68 patients with subacute thyroiditis,using traditional Chinese medicine decoction(honeysuckle,dandelion 30 g to 30 g,the leaf 30 g,xuan and 20 g,yanhusuo,20 g salvia miltiorrhiza,20 g about 10 g,fructus arctii 10 g,forsythia,10 g,liquorice 10 g,etc.)oral treatment,adopt the method of its own before-and-after,record the patient’s general information,symptoms and signs,biochemical examination index(thyroid function,blood routine,liver function,blood sedimentation,thyroid ultrasound,etc.)and prescription drugs.WPS 2019 and SPSS 21.0 were used to establish the database for statistical analysis of all the data.results1.General information:Gender:among the 68 subjects,there were 58 females(85.29%)and 10 males(14.71%),with a male to female ratio of about 1:6.Age:the oldest was 67 years old,and the youngest was 18 years old,with an average age of 41.96 9.35 years old.2.Clinical features:Onset time distribution:16(23.53%)in spring,22(32.35%)in summer,16(23.53%)in autumn,and 14(20.59%)in winter.Cluster in July and August,a total of 26.47%of the year.Before treatment,30 patients(44.12%)had a history of hormone use,38 patients(55.88%)had not used hormones,and the duration of hormone use was 56.19 56.63,30(30,60)days.47 cases(69.12%)were in the stage of hyperthyroidism at the first visit,5 cases(7.35%)were in the stage of hypothyroidism,and 16 cases(23.53%)were in the stage of convalescence.Only 3(4.41%)patients with fever,20(29.41%)patients with thyroid region pain,41(60.29%)patients with fever and pain,and 4(5.88%)patients with neither fever nor pain were observed at the first visit.Heat:68 patients with fever in 44 cases,including low thermal(37～38℃)in 30 patients(68.18%),medium heat(38～39 ℃)in 11 cases(25.0%),fever(39～40℃)in 3 cases(6.82%).Thyroid region pain degree:among the 68 patients,61 patients had thyroid region pain at the time of visit,including 20 patients with mild pain(32.79%),39 patients with obvious pain(63.93%),and 2 patients with severe pain(3.28%).3.The course of the disease:Pretreatment course:median 30(18,60)days.Duration of hyperthyroidism:43.89 33.101;35(25,60)days;Duration of hypothyroidism:71.25 52.738;47.5(30,101.25)days;Recovery time:102.32 102.45;60 days(30,180 days).The mean duration of the disease was 5.40 3.715 months.Median age:5(2.63,6 months);Minimum January,maximum 20 months.4.Thyroid function changes:30 patients(44.78%)experienced typical hyperthyroidism-hypothyroidismconvalescence,22 patients(32.83%)experienced typical hyperthyroidism-hypothyroidismconvalescence,and 16 patients(22.39%)were in convalescence at the time of diagnosis.Persistent hypothyroidism(lifelong hypothyroidism)in 10 patients.The four seasons incidence distribution of patients with typical stage iii was 5 in spring,13 in summer,5 in autumn and 7 in winter.The four seasons that experience not typical stage patient come on:spring 5 people,summer 6 people,autumn 6 people,winter 5 people.Four seasons incidence of lifelong hypothyroidism patients:4 in spring,4 in summer,2 in autumn,and 0 in winter.5.Efficacy evaluation:The febrile duration was the shortest(3 days)and the longest(60 days),with an average of 13.14 10.77 days and a median of 11(7,15)days.The patients with the shortest pain disappearance time were 6 days,the oldest 210 days,and the average pain relief time was 37.19 40.80 days,with a median of 27.50 days(15.25,34.75).The mean time to return to normal was 47.58 44.02 days,with a median of 35(20,60)days.Comparison of TCM symptom and sign scores before and after treatment:the scores of all symptoms and signs after treatment were significantly lower than before treatment,and the difference was statistically significant by Wilcoxon symbolic rank sum test(P<0.001).Curative effect:after treatment,68 patients were cured in 41 cases(60.2%),22 cases(32.3%),5 cases(7.3%),0 cases(none),and the total effective rate was 100%.6.Correlation analysis and difference analysis:(1)hyperthyroidism period without the use of traditional Chinese medicine,the longer the hypoechoic disappearance time(rho=-0.52,p=0.02);The person that USES Chinese traditional medicine in the period of hyperthyroidism:the shorter the convalescence period time(rho=-0.38,p=0.03),low echo still saves the rate after treatment is lower(rho=-0.37,p=0.01),the more do not exist at least continuous 2 months of discomfort symptoms,and the symptoms after treatment integral signs points smaller.(2)abnormal liver function during hyperthyroidism is strongly correlated with AST and ALT values,and is significantly correlated with GGT level,but not with ALP.(3)The thyroid volume of patients with transient hypothyroidism in the course of disease was not different from that of the group without hypothyroidism.After treatment,the thyroid volume of the lifelong hypothyroidism group was significantly smaller than that of the normal group(5.94 2.19).10.98 7.58,P=0.036).(4)in the lifelong hypothyroidism group,the abnormal probability of liver function in the period of hypothyroidism was significantly greater than that in the non-lifelong hypothyroidism group(p<0.0001).The blood esr in the lifelong hypothyroidism group was significantly higher than that in the non-lifelong hypothyroidism group(19.89 14.43mm/h).11.07 8.04mm/h,P=0.036).(5)the greater the peak value of hyperthyroidism stage blood sink:the greater the peak value of FT3 hyperthyroidism(rho=0.37,p=0.01),the lower the TSH value of hyperthyroidism stage TSH(rho=-0.38,p=0.01),the more abnormal liver function of hyperthyroidism stage(rho=0.32,p=0.03),the smaller the FT4 stage of hypothyroidism(rho=-0.54,p<0.01),the longer the blood sink normal need time(rho=0.45,p<0.01).(6)hyperthyroidism stage number of days and the number of days minus a positive correlation(rho=0.61,p=0.01).(7)the greater the peak value of FT3 in the hyperthyroidism stage,the greater the value of AST,ALT(rho=0.42,p=0.04;Rho=0.43,p=0.03).conclusion1.There was no significant difference in the incidence of four seasons,but it could still be seen that the incidence of SAT clustered in July and August,and the thyroid function of patients with summer onset was more likely to experience a typical stage iii evolution.2.The onset of SAT is mainly female,and most cases occur between 35 and 50 years old.3.SAT fever is mainly low fever,rarely high fever;Pain is usually mild to moderate.4.The average antipyretic time was 13.14 10.77 days,and the average analgesic time was 37.19 40.80 days.5.Duration(days)before treatment:30(18,60);Duration of hyperthyroidism(day):43.8933.101;Duration of hypothyroidism(days):71.25 52.738;Recovery time(days):102.32102.445;Total course(month):5.40 3.715.6.Compared with users only in hypothyroidism and convalescence,users using traditional Chinese medicine during hyperthyroidism can make hypoechoic disappear faster,relieve persistent discomfort symptoms and shorten convalescence time.7.Transient liver function abnormalities in the hyperthyroidism stage mainly include cereal straw transaminase,cereal propyl transaminase and GGT abnormalities,all of which are less than 3 times of ULN.8.The thyroid volume of the lifelong hypothyroidism group was significantly smaller than that of the general group.9.Patients with abnormal liver function during hypothyroidism are more likely to have lifelong hypothyroidism.10.The esr in the lifelong hypothyroidism group was significantly higher than that in the non-lifelong hypothyroidism group.11.The peak value of esr and the recovery time can reflect the severity of SAT(degree of thyroid damage)and the recovery time required.It is suggested that doctors should test esr regularly for SAT patients,which is of clinical significance.12.The more severe the thyrotoxicosis,the higher the liver function(mainly AST and ALT).13.The treatment of subacute thyroiditis with heat-clearing and detoxification method can significantly improve the clinical symptoms and signs of the patients as well as the erythrocyte sedimentation rate,with definite curative effect.