Treatment Of Hashimoto's Thyroiditis By Clinical Study On The Syndrome Of Spleen Deficiency And Qi Stagnation And Phlegm Resistance Syndrome With TCM

Object:The main purpose of this thesis is to propose thinking and strategies for the treatment of Hashimoto's thyroiditis(HT)with tradition Chinese medicine(TCM)by clinical study and the research progress of TCM regarding pathogenesis mechanism,diagnose,syndrome differentiation,and treatment of HT ancient and modern.Patents with HT,differentiate as Spleen qi Phlegm syndromes,were treated by spleen strengthening,regulating vital energy,and reduce phlegm methods and followed by the evaluation of clinical symptoms?physical signs?size of thyroid,and serum indicators of thyroid-stimulating hormone(TSH),free triiodothyronine(FT3),free thyroxine(FT4),thyroglobulin antibody(TGAb),thyroid microsomal antibody(TMAb),and thyroid p,eroxidase antibody(TPOAb)to estimate the.efficacy and safety.By this evaluation,the influence of antibody level of patients with HT after TCM treatment could be clarified as an objective evdiance for clinical application in the future.Methods:Sixty patients were randomly devided into two group including treatment and control for a parallel study.Patients of control group and treatment group were treated with regular western drag,sodium thyroxine(Euthyrox(?);Merck)and TCM,respectively.Results:Sixty HT patients(thirty of treatment group and thirty of control group)differentiate as Spleen qi Phlegm syndromes were enrolled in out-patient clinic of hospital.Before treatment with drugs,the data regarding sex,age,and course of disease of each group was analyzed by statistical methods.The results showed non-significant difference between two groups indicated the enroll patients of each group are comparable.(1)Serum TSH concentration comparison:After treating with either TCM or sodium thyroxine(Euthyrox(?)),the intra-group serum FT3 and FT4 level were significant increased(P<0.01).On the contrary,TSH level was significant decreased(P<0.01).When comparing the serum TSH level between control and treatment group,the patient improvment of treatment group was significantly superior than control group(P<0.01).(2)Thyroidal related antibodies concentration comparison:The concentration of thyroidal related antibodies in serum of each group was demonstrated similar(P>0.05)before drug treatment,indicated the enroll patients of each group are comparable.The results of intra-group comparison revealed TGAb and TMAb were significant decrease(P<0.01)after treating with either TCM or sodium thyroxine(Euthyrox(?)).The results of inter-group comparison revealed the decline level of TGAb and TMAb of treatment group was superior than control group with P<0.05 and P<0.01,respectively.(3)Thyroidal size and isthmus thickness comparison:Before any drug treatment,the size of thyroid and the thickness of isthmus were demonstrated similar(P>0.05)indicated the enroll patients of each group are comparable.After treating with either TCM or sodium thyroxine(Euthyrox(?)),the size of right and left lobe of thyroid and the thickness of isthmus showed significant decrease(P>0.01)within inter-group comparison.The inter-group comparison showed patients treat with TCM significantly decrease the thyroid size and isthnus thickness than Euthyrox(?)treatment with P<0.05 and P<0.01,respectively.(4)Single symptom comparison differentiated by TCM:The result of intra-group comparison of each group revealed that the clinical symptoms including front neck swelling,emotional depression,neck infraction,anorexia,abdominal distention after meal,susceptible sigh,and sticky loose stools were significant improved(P<0.05 or P<0.01)after drug treatment.The result of inter-group comparison revealed that the improvement level of each single symptom of treatment group was significant better than control group with P<0.05.(5)Syndrome score comparison:The result of intra-group comparison showed the syndrome score was significant decrease(P<0.01)after drug treatment of each group.The result of inter-group comparison showed the decline level of syndrome score of treatment group was better than control group with statistical difference(P<0.01).(6)Syndrome comparison:After TCM treatment of 30 patients of treatment group,3 patients were healed,11 patients feel significant effective,15 patients feel effective,and one patient was invalid.The total effective ratio was calculated as 96.67%.After treating with Euthyrox(?)of thirty patients of control group,no patient was healed and feel significant effective.There were 8 patient feel effective and 22 patients feel invalid.The total effective ratio was calculated as 26.67%.The total effective ratio of treatment group was significantly higher(P<0.01)than control group after stastical analysis.(7)Safety index:The blood,urine,stool,and the function of kidney and liver were regular exam.ined and the results.showed;normal indicated all groups do not induce allergic reaction and adverse effect after drug administration.Conclusions:The Results of this clinical study revealed that HT patient,differentiate as Spleen qi Phlegm syndromes,treat with Xiaoyingtang coupled with Euthyrox(?)could regulate TSH level,decrease the concentration of thyroidal related antibody,diminish the size of thyroid and the thickness of isthmus,and improve symptoma and syndromea differentiated by TCM.In addition,the safety concern was also had been demonstrated.Therefore,this TCM treatment method is worthy to be further studied,applied,and popularized.