| Objective:The general conditions,clinical data and TCM evidence of 170 patients with Hashimoto’s thyroiditis with hypothyroidism were collected and analysed.The results of thyroid function and thyroid autoantibody tests in patients with Hashimoto’s thyroiditis with hypothyroidism were analysed by incorporating objective laboratory indicators from Western medicine into the TCM evidence system,and exploring the correlation between evidence type and thyroid biological test indicators.The aim is to promote the standardization and objectification of TCM evidence,and to provide objective evaluation indicators for the classification of TCM evidence of Hashimoto’s thyroiditis with hypothyroidism.Research methods:Patients diagnosed with Hashimoto’s thyroiditis with hypothyroidism who visited the Department of Endocrinology,Third Affiliated Hospital of Beijing University of Chinese Medicine between October 2021 and October 2022 were selected for inclusion in the study according to the nadir criteria.The "Hashimoto with Hypothyroidism Chinese Medicine Evidence Questionnaire" was drawn up with reference to the relevant contents of the chapter "Classification and Code of Chinese Medicine Evidence(Revised Edition)" of the chapter on Thyroid disease in the 10th edition of the Planning Textbook of Higher Chinese Medicine Colleges and Universities,Internal Medicine of Chinese Medicine and External Medicine of Chinese Medicine(New Century Second Edition).Then information on the patient’s four TCM consultations was collected,and two TCM endocrinologists(with the titles of associate high and above)came to the patient to conduct TCM evidence classification,which was divided into the liver depression-qi stagnation evidence,qi and yin deficiency evidence,phlegm and stasis intertwined evidence,and spleen and kidney yang deficiency evidence.Patients’ names,ages,genders,past medical histories and past medications,laboratory physicochemical indicators such as TPOAb,TGAb,TRAb,TSH,FT3,FT4,TT3,TT4,etc.Then collected to establish a database,and data analysis was performed using SPSS 25.0 software to analyse the correlation between the TCM patterns of Hashimoto’s thyroiditis with hypothyroidism and other objective information.Research result:1.A total of 170 patients with Hashimoto’s thyroiditis with hypothyroidism were collected in the study.The age distribution of the 170 patients ranged from 19 to 84 years old,with 94(55.29%)in the young group(≤40 years old),60(35.29%)in the middle-aged group(41-65 years old)and 16(9.41%)in the elderly group(>65 years old).2.The prevalence of Hashimoto’s thyroiditis with hypothyroidism was significantly higher in women than in men,with 84%of women and 16%of men.3.TCM evidence composition ratio,of which 61 cases(35.88%of the total number of cases)had evidence of spleen and kidney yang deficiency,accounting for the highest proportion;followed by 40 cases(23.53%of the total number of cases)with evidence of liver depressionqi stagnation;36 cases(21.18%of the total number of cases)had evidence of phlegm and stasis intertwined;and 33 cases(19.41%of the total number of cases)had evidence of qi and yin deficiency,with the lowest prevalence.19.41%.4.There was a statistical difference in the overall age distribution of the four groups(P<0.01);there was a statistical difference in the prevalence of the four groups(P<0.05).5.There was a statistical difference in the overall distribution of TPOAb levels between males and females(P<0.05),TGAb levels between males and females(P<0.05)and TT3 levels between males and females(P<0.05).6.There were statistical differences in the overall distribution of TPOAb levels in different age groups(P<0.05),with the highest overall distribution of TPOAb levels in the middle-aged group and the lowest in the elderly group;there were statistical differences in the overall distribution of FT3 levels in different age groups(P<0.05),with the highest overall distribution of FT3 levels in the youth group and the lowest in the elderly group.7.There was a statistical difference in the length of illness between the four groups of TCM evidence(P<0.05).There was a close relationship between TT4 levels and the length of illness,with a positive correlation between the two(P<0.05).8.TPOAb levels were closely related to TSH,with a positive correlation(P<0.05).TGAb levels were closely related to TSH,with a positive correlation(P<0.05).TGAb levels were closely related to TT4,with a negative correlation(P<0.05).trab levels were closely related to TT3,with a positive correlation(P<0.05).9.There were statistical differences in the overall distribution levels of TPOAb,TGAb,TSH and TT4 among the four TCM evidence groups(P<0.01).Research conclusion:1.The prevalence of HT with hypothyroidism is significantly higher in women than in men,and the ratio of male to female cases in this study is about 1:5,with middle-aged and young people being the majority.2.Women with HT hypothyroidism generally have higher levels of elevated thyroid autoantibodies than men,and as autoantibodies rise,thyroid function is impaired to a greater extent.Also,while HT is associated with progressive decreases in thyroid function with age,thyroid autoantibody levels are higher in youth and middle age,rather than in old age.3.There is a correlation between thyroid autoantibodies and thyroid function.TPOAb is positively correlated with TSH,TGAb is positively correlated with TSH,TGAb is negatively correlated with TT4,and TRAb is positively correlated with TT3.4.HT with hypothyroidism had the highest prevalence of the four TCM evidence types:spleen and kidney yang deficiency.There was a statistically significant difference in gender between the different TCM evidence groups,with the prevalence of spleen and kidney yang deficiency evidence being higher in females,while the prevalence of the liver depression-qi stagnation evidence,phlegm and stasis intertwined evidence,and qi and yin deficiency evidence were higher in males.There were differences in the overall age distribution of the different types of symptoms,with the highest overall age distribution for spleen and kidney yang deficiency evidence,followed by qi and yin deficiency evidence and phlegm and stasis intertwined evidence,and the lowest overall age distribution for the liver depression-qi stagnation.5.Patients with HT with hypothyroidism had the longest duration of illness in the spleen and kidney yang deficiency group,and TT4 levels were positively correlated with the duration of illness.6.The overall distribution of TPOAb and TGAb were in descending order of spleen and kidney yang deficiency,phlegm and stasis intertwined,qi and yin deficiency,and the liver depression-qi stagnation,and the levels of TPOAb and TGAb were closely related to yang deficiency.7.The indicators of hypothyroidism in the liver depression-qi stagnation evidence were more obvious than in the other three groups,with the highest overall distribution level of TSH and the lowest overall distribution level of TT4. |
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