The Treatment of Modern Western - Biblio.nhat-nam.ru

38HYPERTHYROIDISMHyperthyroidism is a clinical condition encompassing severalspecific diseases. Also called thyrotoxicosis, it is characterizedby hypermetabolism and elevated serum levels of freethyroid hormones. Some of the diseases which may causeincreased synthesis and secretion of thyroid hormones areGrave’s disease, an autoimmune disease, anterior pituitarytumors stimulating TSH secretion, molar pregnancy, choriocarcinoma,and various types of thyroiditis. However, thesigns and symptoms of hyperthyroidism are the same foralmost all types. Common signs and symptoms are goiter,tachycardia, warm, fine, moist skin, tremors, palpitations,nervousness, increased activity, increased sweating, hypersensitivityto heat, increased appetite, weight loss, insomnia,fatigue, weakness, and increased frequency of bowel movements.Eye signs associated with hyperthyroidism includestaring, lid lag, lid retraction, and mild degrees of conjunctivalinjection. Thyroid storm refers to the abrupt onset ofmore florid symptoms of hyperthyroidism, such as fever,marked weakness and muscle wasting, extreme restlessnessand emotional lability, confusion, psychosis, and even coma.The Western medical diagnosis of hyperthyroidism is basedon the patient’s history, physical examination, and routinethyroid function tests. Once hyperthyroidism has been established,a thyroid radioactive iodine uptake test may be performedto determine the cause of the hyperthyroidism. InGrave’s disease, blood analysis may reveal antibodies againstthe thyroid TSH receptors. Depending upon its etiology, theWestern medical treatment of hyperthyroidism may consistof administration of iodine. Propylthiouracil and methimazoleare both antithyroid drugs which decrease the organificationof iodine and impair the coupling reaction. Beta-blockers,such as propranolol, may help control the symptoms ofhyperthyroidism due to adrenergic stimulation. In the UnitedStates, radioactive sodium iodine is the most common treatmentof hyperthyroidism. It is the treatment of choice forGrave’s disease and toxic nodular goiter. It works by ablatingall or part of the thyroid. Consequently, 25% of patients prescribedthis drug go on to become hypothyroid within oneyear of its use, with the incidence of hypothyroidism continuingto increase yearly thereafter. Surgical treatment, i.e.,ablation, is indicated for younger patients with Grave’s diseasewhose disease has recurred after courses of antithyroid drugand who refuse radioactive sodium iodine.CHINESE DISEASE CATEGORIZATION: Hyperthyroidismmainly comes under the category of ying qi or qi ying, goiter,in Chinese medicine. In terms of its main clinical manifestations,it may also be categorized as xiao ke, wasting andthirsting, shi yi, eating again, as in rapid hungering after eating,jing ji, fright palpitations, zheng chong, fearful throbbing,etc.DISEASE CAUSES: Internal damage by the seven affects,unregulated eating and drinking, aging, enduring diseaseDISEASE MECHANISMS: The mechanisms of this diseaseare closely related to the liver. Mostly it is due to internaldamage by the seven affects. If liver depression is not outthrust,the qi mechanism may become depressed and stagnant.Then dampness and phlegm may congeal and bind. Itis also possible for enduring depression to transform into fire.If phlegm is drafted up to the heart by depressive heat, theorifices of the heart may be confounded by phlegm and theheart spirit may be harassed by fire. If depressive heat or fireendure, they may burn and damage yin fluids, thus resultingin yin vacuity with fire effulgence. Since “strong fire eats qi,”this may further result in qi and yin both becoming damaged.If liver fire assails the stomach, the stomach may become hot.If a replete liver assails the spleen, the spleen becomes vacuousand weak. Therefore, though the liver is typically at thecenter of the disease mechanisms associated with the productionof all the clinical manifestations of this disease, it alsoinvolves the heart, stomach, spleen, and kidneys.