CHAPTER 9 Hashimoto’s thyroiditis

Hashimoto’s thyroiditis is a chronic inflammatory autoimmune disease of the thyroid gland. The disease is named after its discoverer, Hakaru Hashimoto. It is also called chronic thyroiditis and Hashimoto’s, and it is one type of hypothyroidism.

1 Western medical aetiology and pathology

The thyroid gland produces two main hormones, thyroxine (or T4) and tri-iodothyronine (or T3). Together, they maintain the body’s rate of metabolism by helping to control body temperature, influence heart rate and help regulate the production of protein. The pituitary gland controls the rate of thyroxine and tri-iodothyronine production by secreting thyroid-stimulating hormone (TSH). In turn, the pituitary is controlled by the hypothalamus, which signals the pituitary gland to release TSH. The amount of TSH secreted by the pituitary depends on how much thyroxine and tri-iodothyronine are in the bloodstream. This process usually works well with the proper balance of TSH, T3 and T4 in the blood.

Hashimoto’s thyroiditis is an autoimmune disorder in which the immune system creates antibodies that damage the thyroid gland by causing inflammation, or thyroiditis. The inflammation impairs the ability of the thyroid to produce hormones, which leads to hypothyroidism. In an attempt to stimulate the thyroid to produce more hormones, the pituitary increases its secretion of TSH, resulting in the hypertrophy of glandular tissue. This is called a goitre, which is an enlarged thyroid gland.

2 Diagnosis by Western medicine

Diagnosis is based on serological tests for antibodies and hormone levels in the blood.

1. Subclinical hypothyroidism: normal free T4, but raised TSH levels.

2. Clinical primary hypothyroidism: low free T4, low T3 and raised TSH levels.

3. Needle biopsy and serological tests for antibodies:

Antithyroid peroxidase antibody: autoantibodies of clinical influence in thyroid disease include thyroid-stimulating antibodies (TSAb), TSH receptor-binding inhibitory immunoglobulins (TBII), antithyroglobulin antibodies (anti-TG Ab) and the antithyroid peroxidase antibody (anti-TPO Ab). Anti-TPO Ab has emerged as the most generally useful marker for the diagnosis and management of autoimmune thyroid disease.

The Anti-TPO Ab was historically referred to as the antimicrosomal antibody. The thyroid peroxidase enzyme (responsible for iodinating tyrosine residue in the thyroglobulin molecule) was subsequently identified as the major microsomal component recognized by these autoantibodies.

Anti-TPO Ab mediates antibody-dependent thyroid cell destruction; its concentration correlates with the active phase of the disease. Measurement of this autoantibody is useful for resolving the diagnostic dilemma presented by the apparent inconsistency between increased TSH and normal free T4 results. Given abnormally increased TSH and euthyroid, or normal T4 results, a positive anti-TPO Ab test result provides strong evidence for early, subclinical autoimmune disease. This assay is also used to monitor response to immunotherapy and to identify at-risk individuals who have a family history of thyroid disease.

4. Cholesterol and triglyceride levels may be increased.

3 Chinese medicine aetiology and pathology

The body’s metabolism is governed by Spleen and Kidney Qi and Yang. The Spleen function is to transport and transform food Essence and provide material basis for the acquired constitution. The Kidney stores the Essence that supports the function of all other organs; it is the foundation of the pre-heaven constitution.

The Spleen cannot function well without Kidney Qi and Yang; if the Kidney is deficient, this may lead to Spleen Qi and Yang deficiency, resulting in insufficient energy to support the Kidney. The Spleen and Kidney promote each other physiologically and also affect one another pathologically. Spleen deficiency affects the Kidney, and vice versa. Eventually, both the Spleen and Kidney develop deficiency together.

Qi is one manifestation of Essence. The patency of Liver Qi is important to help Spleen Qi function well. Water and food are the chief source of the nutrients that maintain life and health after birth; they are also the material basis for the production of Qi and Blood, which the Spleen transports, distributes and transforms. If there is Spleen dysfunction, this will cause poor absorption and delivery of nutrients, and the person will have fatigue and weak muscles. There will also be poor transformation of water, which can cause water retention and inability to control Blood circulating in the vessels. In women, this can result in heavy menstrual flow.

When Spleen Qi is deficient, food Essence cannot be transformed in a timely way. It may accumulate in the Middle Jiao, which can block the smooth flow of Liver Qi in the channels, causing Liver Qi stagnation and Blood stasis. This may also cause goitre and emotional disorder.

Spleen Qi deficiency can develop into Yang deficiency and then affect Kidney function, making the disease more severe.

4 General treatment principle

Replenish Spleen Qi and Kidney Qi or warm Spleen Yang and Kidney Yang, promote the flow of Liver Qi and remove Blood stasis.

Differentiation and Treatment

1 Spleen Qi Deficiency

2 Spleen Qi Deficiency with Liver Qi Stagnation

Clinical Manifestations

Fatigue, depression, panic, weight gain and discomfort in the throat with the sensation that there is something lodged in it that cannot be swallowed (plum pit sensation). The tongue is pale with teeth marks and a thin, white coating. The pulse is deep and thready.

Treatment Principle

Nourish Spleen Qi and smooth Liver Qi.

Acupuncture

ST-9 Renyin, Ren-22 Tiantu, BL-18 Ganshu, ST-36 Zusanli and LIV-3 Taichong.

Supplementary Treatment

If a female patient has heavy menstrual flow, add Ren Shen Ginseng Radix, and needle and apply moxibustion to SP-1 Yinbai.

3 Qi Deficiency and Blood Stasis

Clinical Manifestations

Fatigue, weakness, sleepiness, decrease in appetite, goitre, hair loss, feeling cold, weight gain, coarse dry skin and constipation. The tongue is pale purple with a thin, white coating. The pulse is uneven or thready.

Treatment Principle

Replenish Spleen Qi and remove Blood stasis.

Acupuncture

ST-9 Renying, Ren-22 Tiantu, BL-20 Pishu, BL-17 Geshu, SP-10 Xuehai and ST-36 Zusanli.

Supplementary Treatment

If a patient has symptoms of constant pain in the stomach, add Yan Hu Suo Corydalis Rhizoma, Xiang Fu Cyperi Rhizoma and Yu Jin Curcumae Radix, and needle ST-25 Tianshu and SP-10 Xuehai.

4 Spleen Qi Deficiency with Water Retention

Clinical Manifestations

Weakness, sleepiness, weight gain, goitre, bradycardia and palpitations, oedema of the skin of the hands, feet and eyelids, and a heavy feeling of the body. The tongue is pale and tender. The pulse is deep and weak.

Treatment Principle

Restore Spleen Qi and eliminate Water.

Acupuncture

ST-9 Renying, Ren-9 Shuifen, BL-20 Pishu, BL-27 Xiaochangshu and SP-9 Yinlingquan.

Supplementary Treatment

If a patient’s cholesterol is high, add Shan Zha Crataegi Fructus and Jue Ming Zi Cassiae Semen, and needle ST-25 Tianshu and ST-40 Fenglong.

5 Spleen and Kidney Yang Deficiency

Clinical Manifestations

Diarrhoea in the early morning, intolerance of cold, cold limbs, fatigue and weight gain. The tongue is pale and tender with a white coating. The pulse is deep, thready and weak.

Treatment Principle

Warm Spleen and Kidney Yang.

Acupuncture

BL-20 Pishu, BL-23 Shenshu, ST-9 Renying, Ren-22 Tiantu, Ren-4 Guanyuan, ST-36 Zusanli and KI-3 Taixi.

Supplementary Treatment

If the patient has oedema, add Ze Xie Alismatis Rhizoma, Che Qian Zi Plantaginis Semen and Yi Yi Ren Coicis Semen, and needle Ren-9 Shuifen and Ren-6 Qihai; if the patient has frequent colds or flu, use SNIFF & RELIEVE¹ aromatherapy and prescribe YU PING FENG SAN/Jade Windscreen Powder with Huang Qi Astragali Radix, Fang Feng Saposhnikoviae Radix and Chen Pi Citri reticulatae Pericarpium, and needle ST-36 Zusanli and Ren-6 Qihai, and apply moxibustion to both points.

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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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Hashimoto’s thyroiditis

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