Clinical Study On The Difference In TCM Symptom Distribution And Anxiety State Of Thyrotoxicosis Caused By GD And SA

Purpose:In this paper,patients with thyrotoxicosis were selected as the research objects,including hyperthyrotoxicosis represented by diffuse toxic thyroiditis（GD）and destructive thyrotoxicosis represented by Subacute thyroiditis（SAT）.To compare the differences in thyroid hormone levels,traditional Chinese medicine（TCM）symptom distribution and anxiety state of thyrotoxicosis caused by two causes,analyze the similarities and differences between them,and preliminarily explore the correlation between anxiety state and thyroid hormone levels and TCM symptom scores in patients with thyrotoxicosis caused by two causes,in order to provide objective basis for TCM disease differentiation and individualized treatment of thyrotoxicosis caused by two causes.Material and method:From March 2021 to December 2022,patients with untreated thyrotoxicosis who first visited the Endocrinology Department of the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine were selected.Patients with thyrotoxicosis who met the inclusion criteria were divided into GD group and SAT group according to the etiology of thyrotoxicosis.The patient’s information was collected,including gender,age,TCM symptom score,insomnia severity index and self-rating anxiety scale.The physical and chemical indexes included serum FT₃,FT₄,TSH,TRAb,TPOAb and TGAb,and FT₃/FT₄ratio was calculated.SPSS 22.0 software was used for statistical analysis.The measurement data with normal distribution were expressed as（x±s）,and the t test was used for comparison between the two groups.Enumeration data were compared byχ2 test.The measurement data of non-normal distribution were expressed as median（quartile）[M（P25,P75）],and the rank sum test was used for comparison between the two groups.Spearman’s nonparametric rank sum test was used for correlation analysis.Fisher’s exact test was used for categorical data.Receiver operating characteristic（ROC）curve was used to analyze the diagnostic value of clinical indicators.A P value of less than 0.05 was considered statistically significant.Results:1.Comparison of general information and physical and chemical test results between the two groupsThe levels of FT₃,FT₄,FT₃/FT₄,TRAb,TPOAb and TGAb in GD group were higher than those in SAT group,while TSH was lower than that in SAT group（P<0.05）.There was no significant difference in age,gender and sleep quality score between the two groups（P>0.05）.2.Comparison of frequency distribution and severity of TCM symptoms between the two groupsThe top ten symptoms in GD group were palpitation,fatigue,sweating,tremor,irritability,fear of heat,weight loss,neck enlargement,shortness of breath,and insomnia.The top ten symptoms in SAT group were anterior neck pain,fatigue,irritability,fever,palpitation,anterior neck swelling,fear of heat,insomnia,breathlessness,hyperhidrosis,and weight loss.The average distribution degree of anterior neck pain and fever in SAT group was higher than that in GD group（P<0.05）.The average distribution degree of palpitation,sweating,tremor,weight loss,hyperphagia,and exophthalmopathy in GD group was higher than that in SAT group（P<0.05）.3.ROC curve analysis of physical and chemical test indicators of the two groupsROC curve showed that TRAb had the largest AUC（0.980）.Secondly,the AUC of FT₃/FT₄ratio was 0.906.When FT₃/FT₄=0.35 was the best diagnostic threshold,the sensitivity and specificity were 87.20%and 85.50%,respectively.The next AUC from high to low was FT₃（0.897）,TSH（0.822）,FT₄（0.777）and TPOAb（0.724）.4.ROC curve analysis of TCM symptoms of the two groupsThe ROC curve results of anterior neck pain,fever,palpitation,sweating,tremor,weight loss,hypereating,exophthalmia and other symptoms showed the AUC from high to low was anterior neck pain（0.930）,fever（0.833）,tremor（0.726）,palpitations（0.671）,hyperphagia（0.667）,and hyperhidrosis（0.595）.5.Correlation analysis of TCM symptom scores and various factors between the two groupsTCM symptom score was positively correlated with sleep quality score,anxiety state score,FT₃,FT₄,FT₃/FT₄and TRAb in GD group（P<0.05）.The TCM symptom score was positively correlated with sleep quality and anxiety score,and negatively correlated with age in SAT group（P<0.05）.6.Comparison of anxiety scores between the two groups and correlation analysis with various factorsThe anxiety score of the GD group was higher than that of the SAT group（P<0.05）.The anxiety score was positively correlated with sleep quality score,TCM symptom score and FT₃in the GD group（P<0.05）.The anxiety score was positively correlated with sleep quality score and TCM symptom score,and negatively correlated with age in SAT group（P<0.05）.Conclusion:1.Palpitations,hyperhidrosis,tremor,weight loss,and polyphagia were more severe in GD than in SAT.2.The symptoms with recognition value for GD were tremor,palpitation,hyperphagia and hyperhidrosis,among which tremor had the highest recognition value.3.The anxiety of GD patients is more serious and affected by FT₃level.The anxiety of SAT patients is not related to thyroid hormone level,but related to age.The anxiety of patients with thyrotoxicosis due to two causes is related to TCM symptom score and sleep quality.