| BackgroundThe incidence of Hashimoto’s thyroiditis is increasing year by year.HT is the main cause of hypothyroidism in non-iodine-deficient areas.HT leads to thyroid dysfunction,which is often accompanied by hyperthyroidism and hypothyroidism,bringing discomfort to patients.HT is an important risk factor for thyroid cancer and abortion in pregnant women.HT can easily cause anxiety and depression,and reduce people’s life happiness index.At present,doctors and patients have been aware of the high incidence and harm of HT,which has improved the level of HT diagnosis and promoted the initiative of people to seek medical treatment.Western medicine examination is very helpful for diagnosing HT and monitoring the progress of the disease.Western medicine uses alternative therapy to treat HT,which can correct Thyroid dysfunction in time,but has poor efficacy in reducing Thyroglobulin Antibod and Thyroid Peroxidase Antibody.The improvement of medical examination level deepens the understanding of thyroid diseases from the microscopic point of view,and provides a favorable basis for the diagnosis of HT in traditional Chinese medicine.TCM treatment based on syndrome differentiation can effectively control the pathogenesis of the phased changes of HT,regulate the imbalance of Yin and Yang,correct abnormal thyroid function,improve clinical symptoms,and reduce the titer of thyroid autoantibodies,with good results.Therefore,it is hoped to obtain the characteristics of modern medical detection indexes of TCM syndrome type based on western medical examination indexes,improve the accuracy of diagnosing HT and determining TCM syndrome type,and effectively guide clinical medication.PurposeThis study explored the correlation between TCM syndrome type and thyroid function,thyroid antibody,namely thyroid size,nature,nodules and other factors in hashimoto thyroiditis patients,so as to obtain the characteristics of modern medical detection indicators of TCM syndrome type.MethodsHT patients treated in the Expert Outpatient Department of Thyroid and International Department of Dongzhimen Hospital of Beijing University of Chinese Medicine from October1,2021 to February 1,2022 were selected as the case sources.Based on literature study and clinical observation,a Questionnaire of TCM syndrome of Hashimoto’s thyroiditis was developed.According to the inclusion and exclusion criteria,265 patients with HT were selected as case sources.General information,seven thyroid function items,thyroid ultrasound examination,including thyroid size,echo,blood flow,thyroid nodules and cervical lymph nodes were collected,and the TCM syndrome questionnaire was filled in.Excel 2007 software was used to input data,SPSS 22.0 software was used for statistical analysis,and the distribution of each factor was described statistically by contingency table.Chi-square test and Fisher’s exact probability test were used for R×C table data.Chi-square trend test was used to study the correlation between each factor and basic information of disease course and age.Binary logistics regression was used to evaluate the correlation between TCM syndrome type and age,course of disease,positive situation of HT antibody,HT antibody level and ultrasonic indicators.The correlation between TCM syndrome type of HT and TPOAb,TGAb,thyroid function,thyroid size,echo,blood flow,nodule,lymph node and other factors under thyroid ultrasound was studied.Results1.Basic informationA total of 265 HT patients were included in this study,including 247(93.2%)females and18(6.8%)males.The current age distribution of patients ranged from 18 to 71 years old,with an average age of 41.0 ± 12.2 years old.The frequency of patients ranged from 18 to 28 years old,29 to 44 years old,45 to 59 years old,and 60 to 71 years old were 39(14.7%),125(47.2%),76(28.7%),and 25(9.4%),with most patients aged from 29 to 44 years old.There were 136(51.3%)cases,74(27.9%)cases and 55(20.8%)cases of HT with the disease course of < 2years,2-5 years and > 5 years,respectively.2.Ultrasonographic distribution of thyroid function,thyroid antibody and thyroid gland in HT patientsAmong HT patients,135(50.9%)had normal thyroid function,89(33.6%)had hypothyroidism,and 41(15.5%)had hyperthyroidism.There were only 37(14.0%)TGAb positive cases,68(25.7%)TPOAb positive cases,and 160(60.4%)double positive cases of HT,the majority of which were double positive cases and TPOAb positive cases.TGAb was normal in 68(25.7%)cases,mildly elevated in 158(58.1%)cases,moderately elevated in 26(9.8%)cases and severely elevated in 17(6.4%)cases.TPOAb was normal in 37(14.0%)cases,slightly elevated in 171(64.5%)cases,moderately elevated in 26(9.8%)cases,and severely elevated in 31(11.7%)cases.In this study,265 patients with HT were included,20 patients did not have thyroid ultrasound reports,and the ultrasound reports of 245 patients were analyzed.Among them,180(73.5%)had normal thyroid size,49(20.0%)had enlarged thyroid,and 16(6.5%)had reduced thyroid size.Among HT patients,9(3.7%)had homogeneous echo,134(54.7%)had honeycomb echo,40(16.3%)had patchy echo,38(15.5%)had cord echo,and 24(9.8%)had nodular echo.In HT patients,130(53.1%)had grade 0 blood flow,42(17.1%)had grade I blood flow,42(17.1%)had grade II blood flow,and 26(10.6%)had grade III blood flow.HT was associated with thyroid nodule in 125(51.0%)cases and cervical lymph node enlargement in 35(14.3%)cases.3.Correlation of thyroid function,thyroid antibody,thyroid ultrasound with age and disease durationHT patients aged 18-59 years were more likely to have normal thyroid function,and those aged 60-71 years were more likely to have hypothyroidism.The incidence of hyperthyroidism in 18-44 years was higher than that in 45-71 years.Overall,the incidence of hypothyroidism increased with age,and the trend was statistically significant(P < 0.05).The disease course of< 2 years was normal in most cases,the disease course of 2-5 years was normal IN most cases,the disease course of > 5 years was normal in most cases.The incidence of hypothyroidism increased with the progression of disease,while the incidence of hyperthyroidism decreased with the progression of disease,and the trend was statistically significant(P < 0.05).There was no significant difference in the change of HT antibody with the disease course and age distribution(P > 0.05).There was no significant difference in the distribution of thyroid size,echo,blood flow,age and disease duration in HT(P > 0.05).The number of thyroid nodules in 18-28 years old was the least,and the number of thyroid nodules in 60-71 years old was the most.The distribution of thyroid nodules increased with age(P < 0.05).There was no significant difference in the distribution of thyroid nodules and disease duration(P > 0.05).There was no significant difference in the distribution of cervical lymph nodes with age and disease duration(P > 0.05).4.Correlation between thyroid function and thyroid autoantibodies and thyroid ultrasoundThere was no significant difference in the distribution of HT alpha work,antibody and cervical lymph node(P > 0.05).HT patients with normal thyroid function were more likely to have normal thyroid size,honeycomb echo,normal blood flow,and nodules,and the differences were statistically significant(P < 0.05).In hypothyroidism,the thyroid gland was mainly reduced,and the echo was mostly cord and nodular,and the difference was statistically significant(P < 0.05).HT hyperthyroidism was dominated by small flake echo,and the difference was statistically significant(P < 0.05).5.Correlation between thyroid autoantibodies and thyroid ultrasoundThyroid size distribution was not correlated with thyroid antibody positive status and TPOAb titer,and the difference was not statistically significant(P > 0.05).Thyroid reduction was mostly distributed in patients with normal TGAb titer,thyroid size was mostly normal in patients with mildly elevated TGAb,and thyroid enlargement was mostly distributed in moderate and severe elevated TGAb,and the difference was close to statistical significance(P= 0.059).There was no significant difference in the distribution of thyroid antibody,echo and blood flow(P > 0.05).Only TGAb positive patients had more thyroid nodules,and the distribution of thyroid nodules decreased with the increase of TGAb titer,and the difference was statistically significant(P < 0.05).There was no significant difference in the distribution of HT antibody and cervical lymph nodes(P > 0.05).6.TCM syndrome type distributionThere were 94 cases(35.5%)of liver depression and spleen deficiency syndrome,52cases(19.6%)of liver fire exuberance syndrome,37 cases(14.0%)of Yin deficiency and fire flourishing syndrome,30 cases(11.3%)of liver stagnation and Qi stagnation syndrome,36cases(13.6%)of spleen deficiency and phlegm-dampness syndrome,and 16 cases(6.0%)of both Qi and Yin deficiency syndrome in HT.7.The distribution of TCM syndrome types of HT is correlated with age and disease durationThere was no significant difference in the distribution of TCM syndrome type,age and disease progression(P > 0.05).8.Correlation between TCM syndrome type of HT and antibody,thyroid function and thyroid ultrasoundThere was no significant difference between TCM syndrome type and antibody positive status,antibody titer change,thyroid function,echo,blood flow,thyroid nodule and cervical lymph node distribution(P > 0.05).There were significant differences in the distribution of thyroid size among different TCM syndrome types(P < 0.05).Most of the thyroid size in the syndrome of exuberant liver fire was normal,and most of the thyroid size in the syndrome of Qi and Yin deficiency was increased.9.Multi-factor analysis of TCM syndrome type of HT and age,course of disease,thyroid function,antibody and thyroid gland by ultrasoundThe change of TPOAb titer(OR = 0.53,P < 0.05)was a factor affecting the syndrome differentiation of strong irregularity and stagnation of liver qi.The higher TPOAb was,the lower the possibility of occurrence of strong irregularity and the higher the possibility of occurrence of stagnation of liver qi.The change of TGAb titer(OR = 0.55,P < 0.05)was a factor affecting the syndrome differentiation of Yin deficiency and fire intensity.The higher TGAb was,the less possibility of Yin deficiency and fire intensity syndrome differentiation.Thyroid size(OR = 0.16,P < 0.05)was a factor affecting the syndrome differentiation of qiYin deficiency.The possibility of syndrome differentiation of Qi-Yin deficiency was low in patients with normal thyroid size.Conclusion1.HT is mainly in young,middle-aged and female population,with the majority of early onset patients.The thyroid function of HT was mainly normal,followed by hypothyroidism and hyperthyroidism.The antibody was mainly double positive and only TPOAb positive,and the antibody titer was mainly slightly elevated.The size of thyroid gland was mainly normal,the echo of thyroid gland was mainly honeycomb,and the nodule echo was the least.The blood flow was mainly grade 0,followed by grade I and II,and the blood flow was the least in grade III.2.The number of patients with hypothyroidism increases with age;With the progression of disease,the number of patients with hypothyroidism increased,and the number of patients with hyperthyroidism decreased.The changes of antibody,thyroid size,echo,blood flow and cervical lymph nodes were not related to age and course of disease.The distribution of thyroid nodules is related to age,and the incidence of thyroid nodules increases gradually with the increase of age.3.Patients with normal thyroid function are more likely to have normal thyroid size,uniform echo,honeycomb echo,normal blood flow,and nodules.Hypothyroidism is more likely to reduce thyroid size;There was no correlation between thyroid function and antibody positive status,antibody grade change and lymph node distribution.4.If only TPOAb is positive,thyroid reduction is more likely.The possibility of thyroid enlargement increased with the increase of TGAb titer.When TPOAb was slightly elevated,thyroid blood flow was more normal,while when TPOAb was severely elevated,thyroid blood flow was more abundant.Thyroid nodules were more likely to occur only when TGAb was positive,and the incidence of thyroid nodules decreased with the increase of TGAb titer.Antibody titer was not correlated with thyroid echo and cervical lymph node changes.5.Among the TCM syndrome types of HT,the syndrome of liver stagnation and spleen deficiency is the most,the syndrome of exuberant liver fire and Yin deficiency and fire are the second,the syndrome of spleen deficiency and phlegm dampness and liver stagnation are less,and the syndrome of Qi and Yin deficiency is the least.6.With the progress of the disease,the syndrome of exuberant liver fire,liver stagnation and Qi stagnation decreased,and the syndrome of Yin deficiency and fire prosperity,syndrome of Qi and Yin deficiency and syndrome of spleen deficiency and phlegm dampness increased.7.Irascibility exuberant card thyroid size is much normal,qi Yin two deficiency card thyroid increases easily.8.The duration of exuberant irascibility syndrome is short,and the titer of TPOAb is low.The titer of TPOAb was high in liver stagnation and Qi stagnation syndrome.The TGAb titer of Yin deficiency and fire flourishing syndrome is low,the course of Qi and Yin deficiency syndrome is long,and the thyroid gland is easy to enlarge.The course of the syndrome of spleen deficiency and phlegm dampness is long.There were no significant changes in liver stagnation and spleen deficiency syndrome with age,course of disease,antibody titer,thyroid function and thyroid B-ultrasound. |
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