CHAPTER 8 Graves’ disease

Graves’ disease occurs when the thyroid produces and secretes more than the normal volume of thyroid hormone into the bloodstream. The cause is an overactive immune response and the result is hyperthyroidism.

1 Western medical aetiology and pathology

Graves’ disease is an autoimmune disease in which T lymphocytes become sensitized to antigens within the thyroid gland and stimulate B lymphocytes to synthesize antibodies, specifically thyrotropin receptor antibody (TRAb). These bind to the surface of thyroid cells. They do not destroy the thyroid cells, but stimulate them to produce excessive amounts of thyroid hormone, while feedback leads to a decline in thyroid-stimulating hormone (TSH), causing hyperthyroidism. The patient’s catabolic processes exceed the anabolic processes. The resulting inflammation of the thyroid gland is responsible for its growth and protrusion of the eyes, two classical signs of Graves’ disease. The causes of Graves’ disease may be a combination of factors, including heredity, gender, age and stress.

2 Diagnosis by Western medicine

The diagnosis of hyperthyroidism is made on the basis of findings during physical examination and confirmed by laboratory tests and the radioactive iodine test:

• Physical examination: enlarged thyroid gland, weight loss, tachycardia and tremors.

• Blood sample: decreased levels of TSH, and raised thyroxine, or T4, and tri-iodothyronine, or T3. In Graves’ disease, an abnormal antibody called TRAb mimics TSH, causing increased thyroxine even while TSH levels remain low. In addition, thyroid-stimulating antibodies (TSAb) will be positive. These results together help diagnose Graves’ disease.

• Radioactive iodine uptake: humans need iodine to make thyroxine. By giving a small amount of radioactive iodine and later measuring the amount of radioiodine in the thyroid gland, the rate at which the thyroid gland takes up iodine can be determined. A high uptake of radioactive iodine indicates the thyroid gland is producing too much thyroxine, as is the case in Graves’ disease.

3 Chinese medical aetiology and pathology

Chinese medical theory does not specifically name hyperthyroidism. However, the symptoms of enlarged thyroid, fatigue, weight loss, tachycardia, muscle weakness, heat intolerance, tremors, palpitations, sweating, blurred or double vision, restless sleep, decrease in menstrual flow and increased frequency of bowel movements seem to be described by such diagnoses as Ying Liu , goitre, Xin Ji , palpitations, Shi Mian , insomnia, and Jiao Lu , anxiety.

The symptoms of Graves’ disease mirror those seen in Liver Fire rising. In Five Elements theory, the Liver belongs to Wood. If Wood (mother) affects Fire (son), and therefore the Heart, we call this ‘diseased mother transferring illness to the son’. This causes palpitations, insomnia and nightmares; Fire singes the Blood and forms Blood stasis. The Wood Fire descends to singe water, leading to Kidney Yin deficiency. In Chinese medical theory, the Liver and Kidney come from the same source. Therefore, when Liver Fire affects the Kidney, it damages not only Kidney Yin but also Liver Yin. When this occurs, it causes thirst, dark and yellow urination that is of low volume, anxiety and reduced volume and period of menstruation. Liver Fire can also travel through the Liver channel and ascend to the Upper Jiao, burning Lung Yin. Should this occur, it can cause hypochondriac pain, irritability, cough with dyspnoea and haemoptysis. This is called ‘Wood Fire impairs Metal’. When Liver Fire affects the Spleen, it causes an increase in the speed of transportation, distribution and transformation, resulting in polyorexia (bulimia) and emaciation. Therefore, as described in ‘The 77th Problem’, a chapter in Nan Jing/The Classic on Medical Problems, ‘When Liver disease occurs it will spread to the Spleen, so the Qi of the Spleen should be reinforced before it is affected’. However, Liver Fire can affect different organs and cause different symptoms and signs.

Generally speaking, Chinese medicine thinks the disease has three causes:

1. Exterior pathogenic Heat invades the body and develops into the disease.

2. Emotional depression and anger lead to the disordered flow of Liver Qi, causing stagnation of Liver Qi. This becomes unfavourable for its normal, physiological activity and causes accumulation of Phlegm and Blood stasis.

3. A genetic predisposition to Yin deficiency, which causes internal Heat and is inherited from the parents.

4 General treatment principle

The primary treatment is to eliminate pathogenic heat from the Liver, clean Heat-Toxin, promote the flow of Qi and remove Blood stasis.

Differentiation and treatment

1 Liver fire flaming up

2 Liver fire rising due to liver yin deficiency

Clinical manifestations

Blurry eyes, thirst, a dry mouth with no desire to drink, tinnitus, palpitations, insomnia, emaciation, tremors and hypomenorrhoea. The tongue is red with less coating. The pulse is thready and rapid.

Treatment principle

Eliminate excess Liver Fire and nourish Yin.

Acupuncture

Du-20 Baihui, Ren-22 Tiantu, BL-18 Ganshu, BL-23 Shenshu and KI-3 Taixi.

Supplementary treatment

If a patient has palpitations and insomnia, add Huang Lian Coptidis Rhizoma, Wu Wei Zi Schisandrae Fructus and Mai Men Dong Ophiopogonis Radix, and needle HE-7 Shenmen and Ren-17 Tanzhong; for night sweats, add Ma Huang Gen Ephedrae Radix, Fu Xiao Mai Tritici Frutus levis and Nuo Dao Gen Oryzae glutinosae Radix, and needle HE-7 Shenmen and KI-7 Fuliu.

3 Liver fire rising with blood stasis

Clinical manifestations

Red eyes, dry mouth, enlarged thyroid gland, insomnia and anxiety. The tongue is red and purple, and the sublingual veins are distended. The pulse is thready and rapid.

Treatment principle

Calm excess Liver Yang and Fire, and remove Blood stasis.

Acupuncture

LIV-2 Xingjian, SP-6 Sanyinjiao, SP-10 Xuehai, BL-23 Shenshu, BL-18 Ganshu, BL-17 Geshu and Ren-22 Tiantu.

Supplementary treatment

If Wood Fire singes Metal, called Mu Huo Xing Jin, there will be a dry cough or even asthma, and difficulty breathing, particularly lying flat on a bed. Add XIE BAI SAN/Drain the White Powder with Sang Bai Pi Mori Cortex and Di Gu Pi Lycii Cortex, and needle Dingchuan (extra) and BL-13 Feishu; if a patient has symptoms of Wood subjugating Earth leading to stomach pain, diarrhoea and a red tongue with teeth marks, add Fu Ling Poria, Bai Zhu Atractylodis macrocephalae Rhizoma and Chen Pi Citri reticulatae Pericarpium, and needle SP-9 Yinlinquan, ST-25 Tianshu and ST-34 Liangqiu.

Case studies

Case one

HS was a 37-year-old woman who, on her first office visit, came in complaining of flushed face, heat intolerance, easy sweating, anxiety, palpitations, a dry cough and itchy throat, eating more than other people, constant hunger and scanty menstruation. She had recently been diagnosed with Graves’ disease and had already been prescribed a beta-blocker.

Physical examination: the thyroid gland was enlarged by two degrees and looked like an apple. Both eyes protruded. Her heart rate was 100 beats/min. She had a pale tongue and thready and rapid pulses.

2 weeks prior to office visit: laboratory results

TSH: 0.04 μIU/mL (normal range 0.5–6.4)

T4: 24.9 ng/dL (4.8–11.5)

T3: 0.58 ng/dL (0.75–1.40)

Free T4: 6.06 ng/dL (0.66–2.0)

Impression:

1. Graves’ disease (Liver Fire rising with Blood stasis)

2. Goitre (Ying Liu)

3. Allergy

4. Cough (Yin and Qi deficiency)

The patient received five bags of herbs per week and acupuncture once a week. She was told to have her thyroid function checked once every 3 months.

Case two

LK was a 50-year-old woman who, on her first office visit, came in complaining of difficult breathing for years, which had recently become aggravated. She could not lie down at night. She had a cough without phlegm, itchy throat, heat intolerance, sweating during both the day and night, and loss of appetite, resulting in her having soup every day for nourishment. She had had a diagnosis of Graves’ disease for over 10 years. In the past, she had even been diagnosed with thyroid storm, a life-threatening crisis. She had constipation and her urine looked like dark soybean soup.

Physical examination: continuing status asthmaticus, goitre, protruding eyes, wheezing breath and heart rate 105 beats/min. Her tongue was red and purple with less coating in front and a fissure in back, with deep teeth marks. Her pulse was deep rapid and thready, and the left guan and right cun were taut.

Laboratory results: Not available.

Impression:

1. Graves’ disease (Wood Fire burns Metal)

2. Status asthmaticus

Treatment principle

Eliminate Liver Fire and calm asthma.

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Tags: Treating Autoimmune Disease with Chinese Medicine

Jan 19, 2017 | Posted by admin in MUSCULOSKELETAL MEDICINE | Comments Off

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