| Objective Hyperthyroidism cases of hospitalized patients with diabetes mellitus were selected to compare their medical history with hyperthyroidism patients whose blood sugar was normal and diabetic patients who had normal thyroid function. After the classification of common TCM syndrome types, the relationship was researched between these different types and patients' history and some objective parameters of relevant examination. By this way, the inherent correlation was expected to be found for hyperthyroidism patients with diabetes to reveal the rules of illness judgment, therapeutic treatment, prognosis evaluation and TCM therapy based on syndrome differentiation.Methods According to the unified diagnostic criteria and different disease characteristics, inclusion and exclusion criteria were determined. Collected clinical data of the patients were divided into 3 groups, including 42 hyperthyroidism cases with diabetes as observed group, 42 hyperthyroidism cases without diabetes as control group A and 42 diabetes cases without hyperthyroidism as control group B. Through the comparative study method, differences were compared between these hyperthyroid with diabetes and those hyperthyroid without diabetes or diabetic without hyperthyroidism in medical history. Further more, these syndrome types of hyperthyroid with diabetes were separated from each other to observe the differences in their medical history and related parameters. Among them, the 42 cases were mainly classified into three syndrome types, including consumption of the body fluid due to excessive heat, hyperactivity of fire due to yin deficiency and deficiency of both qi and yin. Meanwhile, the related factors referred to thyroid function(FT3, FT4 and TSH), fasting plasma glucose, haemoglobin A1 c, blood lipid(TC, TG, LDL-C and HDL-C), carotid duplex ultrasound, thyroid ultrasound, etc. Finally, all the results were analyzed with SPSS19.0 statistical software.Results(1)There were no significant differences checked by statistical methods between observed group and control group A in terms of gender ratios and average age(P>0.05). Between both, the proportion of women of control group A was slightly higher than that of observed group, but the average age of control group A was lower. There was a small but not significant difference between observed group and control group B in gender ratios(0.01<P<0.05). Meanwhile, a significant difference was present in average age between observed group and control group B(P<0.01). The proportion of women of control group B was lower than that of observed group, but the average age was higher. The prevalence rates of patients' previous dyslipidemia, hypertension and coronary disease history made no obvious differences between observed group and control group A(P>0.05). The prevalence rates between observed group and control group B presented the same result(P>0.05). Among both, the post history in control group A was lower than that in observed group. The prevalence rate of patients' previous dyslipidemia history in control group B was slightly higher than that in observed group, but the prevalence rates of patients' previous hypertension and coronary disease history were lower.(2)There were no significant statistical discrepancies in detection rates of goiter, detection rates of thyroid nodule with the largest diameter>1cm or hypoechoic nodules between observed group and control group A(P>0.05). But the control group A had a higher level of the detection rates of goiter, thyroid nodule with the largest diameter>1cm and hypoechoic nodules than observed group. In addition, the detection rates of goiter showed an evident difference between observed group and control group B(P<0.01). But the detection rates of thyroid nodule with the largest diameter>1cm and hypoechoic nodules between observed group and control group B did not(P>0.05).(3)Among the common TCM syndrome subgroups,the type of hyperactivity of fire due to yin deficiency was the most accounted for 52.4%. The second was the type of hyperactivity of fire due to yin deficiency, of which the proportion was 35.7%. Simultaneously, the syndrome type of consumption of the body fluid due to excessive heat was present in small amounts, holding the rate of 11.9%.(4)There were significant statistical discrepancies between the syndrome of consumption of the body fluid due to excessive heat and the other two subgroups in mean duration and BMI(P<0.01). However, both the others shared little differences in these respects(P>0.05). As to patients' past history, no data showed evident differences among the three subgroups(P>0.05). As a result, it had a shorter course, lower BMI and more rare percentages of previous history of hypertension, coronary disease or dyslipidemia.(5)The values of FT3, FT4, TSH, FPG and Hb A1 c in the syndrome subgroup of consumption of the body fluid due to excessive heat, which emerged at higher levels of FT3, FT4, FPG, Hb A1 c and a lower level of TSH, presented some statistical discrepancies compared with those in the other two syndrome subgroups(P < 0.01). While, the remaining two subgroups did not hold obvious differences at the levels of FT3, FT4, TSH, FPG and Hb A1c(P>0.05).(6)The levels of TC, TG, LDL-C and HDL-C did not prominently separate all the syndrome subgroups from each other(P > 0.05). But the syndrome subgroup of consumption of the body fluid due to excessive heat presented a lower degree than the others. There was a small but not significant difference in patients' IMT between the syndrome of consumption of the body fluid due to excessive heat and the syndrome of deficiency of both qi and yin(0.01<P<0.05). At the same time, both made no evident differences compared with the syndrome of hyperactivity of fire due to yin deficiency(P>0.05). The prevalence rates of artery atheromatous plaque showed no significant differences in the three syndrome types(P>0.05).Conclusion In this study, patients with diabetes were more likely to have hyperthyroidism than normal population, which was mainly caused by disease itself and had nothing to do with patients' other history. The common TCM syndrome types of hyperthyroid with diabetes mainly presented the deficiency syndrome, such as hyperactivity of fire due to yin deficiency and deficiency of both qi and yin. Of course, it expressed in a critical condition the excess syndrome, like consumption of the body fluid due to excessive heat. This conclusion was also supported to some extent by objective parameters of relevant examination, namely thyroid function, blood sugar control, blood lipid, etc. When patients were clinically acute onset, both hyperthyroidism and diabetes mellitus should be controlled actively. After related parameters returned to normal, continued treatments were still needed to consolidate the patients of yin deficiency. |
PDF Full Text Request