甲状腺功能亢进症中西医疗法介绍

Hyperthyroidism Chinese and Western medical law describes the disease there is no specific therapy, patients should avoid stress on the disease disadvantage factors, attention to proper rest, adequate intake of calories and vitamins, to supplement the disease caused by consumption. Treatment of the main purpose is to control high metabolic syndrome, promote immune monitoring normalization. Traditional Chinese and Western medicine treatment of 1 anti thyroid drugs ( 1) indications : application to①symptoms are relatively light, light, moderate thyroid enlargement;②for children under 20 years of age, children, elderly patients;③pregnant women;④after subtotal thyroidectomy recurrent and not suitable for I131 treatment; the preoperative preparation, or as a I131 treatment auxiliary means. Commonly used with methyl or propylthiouracil, methimazole and hyperthyroidism equality.

( 2) the dosage and duration of treatment: general treatment usually: 1.5 ~ 2 years is appropriate, but large individual differences. The initial phase of methimazole or hyperthyroid flat daily 30 ～40mg, 6～ 8 weeks later the symptoms were obviously improved, weight gain, heart rate decreased to 80～ 90 times / min, T4 or T3 close to normal, according to the condition of each of the 2～ 3 weeks decreased dose 1 times, each time in the process of reducing 5mg, observe closely the condition, try to keep the thyroid function in normal and stable. Reducing drug phase typically lasted for 2～ 3 months, gradually transition to the maintenance phase. The maintenance phase of the daily dosage is 5～ 10mg, stops the medicine before can be reduced to 2.5～ 5mg, for a period of approximately 1 to 1.5 years or even longer.

( 3) treatment for attention of avoiding discontinuous medication treatment, should be passion situation should include an increase in dose, to be stable after the decline. The drug can appear after agranulocytosis, especially in those with methyl thiouracil treatment. The initial stage is required every 1～ 2 weeks, reducing agents and maintenance stage every 2 to 4 weeks to review the white blood cell count and classification, if the count is less than 4 × 10*9 / L, can be observed under the pine oral, if the period is less than 3 × 10*9 / L should stop drug. After use of the drug may also occur in other adverse drug reaction, such as drug eruption, the elevation of serum ALT, joint pain, gastrointestinal symptoms, should make corresponding processing or change with antithyroid drugs.

Treatment of hyperthyroidism and antithyroid drug therapy in the most serious side effect is neutropenia, agranulocytosis, due to granulocytic small systemic resistance decreased significantly, resulting in severe systemic infection, the threat to life great. ( 4) adjuvant drug therapy:①during antithyroid drug therapy for the initial 1 to 2 months, can be combined usingβ- blocker propranolol 10～ 20mg, 3 times a day, can improve the heart palpitations, tachycardia, nervousness, heartbeat, sweating symptoms such as tremor. ②reducing drug period begin to add small dose thyroid stem preparation, daily 0.03 ～0.06 or thyroxine 50～ 100 μ g, to stabilize the hypothalamus hypophysis thyroid axis coordination, prevent goiter and more severe ophthalmopathy.

2 radioactive I131 treatment ( easily lead to hypothyroidism / A, mainly refers to the permanent hypothyroidism / a ) ( 1) indications : application to①over the age of 25 years old;②antithyroid drug allergy and can not continue to use, or long-term treatment is ineffective, or relapse after stopping;③thyroid subtotal recurrence after surgical resection;④with heart disease, diabetes, severe liver, kidney disease and not operation; the patients with hyperthyroidism exophthalmos. ( 2):①contraindications to pregnancy or breastfeeding women; the aged less than 25 years; the activity of liver, kidney disease patients; the total number of cells is less than 3× 10*9 / L; the severe hyperthyroidism patients; the nodular goiter accompanied by hypersplenism, nodules as " cold nodule " ( 3) treatment method and dose: usually in thyroid weight and 131I maximum absorption ratios as decision dose reference, formula: I131 dose of MBq (μ Ci ) =2.6 ～3.7MBq ( 70～ 100 μ Ci )×thyroid weight ( g ) / thyroid maximum absorption I131 dose rate determined after fasting time export clothing, such as the dose is too large ( more than 740MBq or 20mCi ), to give a total dose of 2 / 3, were observed in 1.5 to 2 months, and then decide whether to give the remaining 1 / 3 quantity.

( 4) treatment of note:①higher than the calculated dose not machinery application, still must according to patient age, disease, previous treatment, I131 in the thyroid gland of the effective half-life of the length to be adjusted. ②I131 before treatment for 2 to 4 weeks to avoid using various iodine-containing foods and drugs. If the condition is serious, before therapy heart rate more than 120 times / min, should begin with antithyroid drugs or treatment with propranolol. Symptom control after discontinuation of, 2～ 3 days, as was I131 determination and then treated with I131, and in I131 after 1～ 2 weeks, can restore the antithyroid drug therapy.

Using 131I treatment for hyperthyroidism was more prominent in the long-term complications of hypothyroidism / A. Generally do not think that this therapy may increase cancer hair full, but due to the age of patients to ionizing radiation sensitive, prudence, for 25 years following adolescent patients to choose other treatments should be. Operation treatment of 3 (1 ): operation indications indications for thyroid enlargement of significant compression of the adjacent organs; the thyroid is larger, antithyroid drugs are ineffective or recurrence after stopping;③nodular goiter with hyperthyroidism;④substernal thyroid;⑤not insist on long-term clothing medicine and hope to control the illness.

( 2) treatment of attention: highly exophthalmos after exacerbation may, therefore, taboo. Operation patients before should with antithyroid drugs to control disease, heart rate recovery to 80～ 90 times / minute following, again with propranolol or propranolol combined with iodide as preoperative preparation. Operation may occur with local hemorrhage, injury to the recurrent laryngeal nerve, the superior laryngeal nerve, thyroid, aggravate exophthalmos and cause permanent hypothyroidism complication. 4 Chinese medicine treatment according to syndrome differentiation treatment of traditional Chinese medicine treatment of hyperthyroidism is mainly in the syndrome type based on syndrome differentiation. Hyperthyroid syndromes evolution has such a law: at the beginning of the disease with liver depression, sputum node, Zhi Yi Qi, Ruanjiansanjie; later Shangyin gas consumption; the latter negative depletion, treatment should be nourishing liver kidney mainly.

Traditional Chinese medicine symptomatic treatment : Traditional Chinese medicine is also commonly used to as hyperthyroidism on symptomatic treatment, such as hyperthyroidism patients with Hyperhidrosis available, oyster shell powder, or large doses of astragalus root, triticum. Hyperthyroidism in common heart palpitations, insomnia, dreams and other symptoms can be hung up, in the general treatment based on the use of Suanzaoren, Polygala, keel, Polygonum multiflorum, mother-of-pearl. A large number of clinical evidence, most patients with hyperthyroidism have deficiency of both qi and Yin performance, of course, on the basis of this may also be combined with other and certificate. Qi medicine and Yin-nourishing medicine in the treatment of hyperthyroidism in this synergy, is the Chinese " Yang Sheng Yin " and " Yang Yin to help source of inexhaustible " theory best annotation.