| Objective:The present study utilized an epidemiological questionnaire survey to collect clinical symptom and sign data from patients with Hashimoto’s thyroiditis(HT)combined with hypothyroidism(hereafter referred to as "hypothyroidism").Modern statistical methods were employed to analyze the distribution pattern of traditional Chinese medicine(TCM)syndrome types in patients with HT combined with hypothyroidism,as well as the related influencing factors,in order to provide theoretical and practical support for the differential treatment of this disease.Method:Design an information collection form for patients with HT and hypothyroidism,select patients who meet the inclusion and exclusion criteria from the Endocrinology Department of the First Affiliated Hospital of Heilongjiang University of Chinese Medicine from November 2021 to December 2022,fill in the collection form,establish a patient database based on the survey results,conduct frequency analysis,cluster analysis,chi-square test,and logistic regression analysis,and summarize the distribution patterns of TCM syndromes and related influencing factors among HT patients with hypothyroidism in this survey.Result:1.Among 232 patients with HT combined with hypothyroidism,219(94.40%)were female patients and 13(5.60%)were male patients,with more prevalence in females.2.Among 232 patients with HT combined with hypothyroidism,the minimum age was 13 years,the maximum age was 72 years,the median age was 45 years,and the mean age was 43.64±13.41 years.The age of the patients was mainly concentrated in 31-60 years old,with the most patients aged 46-60 years old.3.232 patients with HT combined with hypothyroidism,the duration of diagnosed hypothyroidism was classified according to ≤2 years,2-5 years,and >5 years,with most patients having a duration of ≤2 years.4.Among 232 patients with HT combined with hypothyroidism,110(47.41%)patients had thyroid nodules,37(15.95%)patients had hyperlipidemia,16(6.90%)patients had diabetes mellitus,19(8.19%)patients had hypertension,12(5.17%)patients had coronary heart disease,10(4.31%)patients had liver injury.5(2.16%)patients had lacunar infarction.5.Among 232 patients with HT combined with hypothyroidism,203(87.50%)patients had subclinical hypothyroidism and 29(12.50%)patients had clinical hypothyroidism,with subclinical hypothyroidism being the majority of patients.6.Among 232 patients with HT combined with hypothyroidism,137(59.05%)patients had no palpable enlargement of the thyroid gland and 95(40.95%)patients had palpable enlargement of the thyroid gland,including 76(32.76%)patients with first-degree enlargement of the thyroid gland,15(6.47%)patients with second-degree enlargement of the thyroid gland,and 4(1.72%)patients with third-degree enlargement of the thyroid gland.7.After reviewing previous studies on ultrasound typing of the thyroid gland and clinical practice in the literature,the maximum bilateral lobe thickness of the thyroid gland in the 232 patients included in this study was divided into three intervals: ≤15 mm,>15 and <21 mm,and ≥21 mm,with 67(28.88%)cases with left and right lobe thickness ≤15 mm,113(48.71%)cases with left and right lobe thickness >15 and <21 mm.The thickness of the left and right lobes was ≥21 mm in 52(22.41%)cases.8.Based on a review of thyroid ultrasound typing and clinical practice studies in the literature,the isthmus thickness of the thyroid gland in 232 patients included in this study was divided into three intervals: ≤3 mm,>3and <6 mm,and ≥6 mm.Among them,102(43.97%)cases had isthmus thickness ≤3 mm,108(46.55%)cases had isthmus thickness >3 and <6 mm,and 22(9.48%)cases had isthmus thickness ≥6 mm.9.According to the results of color Doppler imaging(CDFI)of thyroid ultrasound,among 232 patients with HT combined with hypothyroidism,94(40.52%)patients had reduced blood flow distribution in the thyroid gland,119(51.29%)patients had normal blood flow distribution,15(6.47%)patients had increased blood flow distribution,and 4(1.72%)patients had abundant blood flow distribution.10.The distribution of TCM evidence in 232 patients with HT combined with hypothyroidism was: 93(40.09%)with liver-depression and spleen-deficiency,66(28.45%)with spleen-kidney-yang-deficiency,42(18.10%)with phlegm-stasis interaction,and 31(13.36%)with qi-yin deficiency.11.The unconditional binary logistic regression model was used to analyze the clinical symptoms that were significant for the respective evidence types.Among them,good tai breath,premenstrual breast distension,irritability,stringy pulse,dry and thin stools,tooth-marked tongue,and loose stools were significantly associated with liver depression and spleen deficiency;facial swelling,swollen limbs,low menstrual flow,soreness and weakness of the waist and knees,and lumbago were significantly associated with spleen and kidney yang deficiency;numbness of the limbs,dysmenorrhea,neck pain,and dark red tongue were significantly associated with phlegm and stagnation;thin pulse,dry eyes,panic,night sweating,red tongue,and constipation were significantly associated with qi-yin deficiency.The symptoms of thin pulse,astringency of the eyes,panic,night sweating,red tongue and constipation are significantly associated with Qi and Yin deficiency.12.The results of the chi-square or Fisher’s test showed that: among patients with thyroid nodules and first-degree enlargement on palpation of the thyroid gland,the proportion of phlegm and stagnation was highest;among patients with subclinical hypothyroidism,the proportion of liver-depression and spleen-deficiency evidence was significantly higher than that of spleen-kidney-yang deficiency evidence,and among patients with clinical hypothyroidism,the proportion of spleen-kidney-yang deficiency evidence was significantly higher than that of liver-depression and spleen-deficiency evidence.Among patients with a thickness of the right and left lobes of the thyroid gland ≤15 mm,the proportion of patients with liver-depression and spleen-deficiency evidence was significantly higher than that of patients with liver-depression and spleen-deficiency evidence,and among patients with a thickness of the right and left lobes of the thyroid gland ≥21 mm,the proportion of patients with liver-depression and spleen-deficiency evidence was the highest.In patients with thyroid isthmus thickness ≥6mm,the proportion of liver-depression and spleen-deficiency evidence was significantly higher than that of liver-depression and spleen-kidney-yang deficiency evidence and phlegm-stasis-intercurrent evidence;in patients with reduced thyroid blood flow signal,the proportion of liver-depression and spleen-deficiency evidence was significantly lower than that of spleen-kidney-yang deficiency evidence and qi-yin-two-deficiency evidence,and in patients with normal thyroid blood flow signal,the proportion of liver-depression and spleen-deficiency evidence was significantly higher than that of qi-yin-two-deficiency evidence.Conclusion:1.Patients with HT combined with hypothyroidism: women are the majority;age is mainly between 31 and 60 years;duration of hypothyroidism is mostly ≤2 years;thyroid nodules and hyperlipidaemia are the most frequent associated diseases;subclinical hypothyroidism is the majority;thyroid enlargement on palpation is mostly first degree;the thickness of the left and right thyroid lobes is mostly>15 and<21 mm;the thickness of thyroid isthmus is mostly>3 and<6mm;the thyroid blood flow distribution is mostly normal.2.There are four main types of hypothyroidism in combination with HT:liver-depression and spleen-deficiency,spleen-kidney-yang-deficiency,phlegm-stasis and qi-yin deficiency.Liver-depression,spleen-deficiency and spleen-kidney-yang deficiency are the main types of HT combined with hypothyroidism.3.There were statistically significant differences in thyroid nodules,thyroid function,thyroid palpation,right and left lobe thickness,thyroid isthmus thickness and thyroid blood flow signal distribution between the different TCM evidence types in HT combined with hypothyroidism. |
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