Hyperthyroidism

//Western Diagnosis// thyrotoxicosis - Grave’s Disease

Etiology
1. unknown, but probably immunologic

Signs & Symptoms
1. nervousness, inc activity 2. inc perspiration, heat intolerance 3. fatigue, weakness 4. inc appetite, weight loss 5. insomnia 6. frequent bowel movements 7. goiter 8. tachycardia, atrial fibrillation 9. warm, moist skin 10. tremor 11. stare

a. infiltrative ophthalmopathy i. exophthalmos ii. ocular muscle weakness b. infiltrative dermopathy i. pretibial edema ii. non-pitting, pruritic edema
 * in Grave’s disease**


 * thyroid storm** - abrupt onset of above sx - life-threatening emergency

Diagnosis
1. decreased TSH 2. elevated free T4 3. elevated T3 uptake 4. elevated T3

Treatment
1. anti-thyroid agents - propylthiouracil 2. radioactive iodine 3. surgery

 Etiology
 - Unknown, but probably immunologic
 *  **Signs and Symptoms of Hyperthyroidism**  ||
 *  - Nervousness, inc activity

 - I ncreased perspiration, heat intolerance

 - F atigue, weakness

 - I ncreased appetite, weight loss

 - I nsomnia

 - F requent bowel movements

 - G oiter

 - T achycardia, atrial fibrillation

 - W arm, moist skin

 - T remor

 - S tare  ||  ** **in Grave’s disease**  **

<span style="font-family: arial,helvetica,sans-serif;"> <span style="font-family: Times New Roman,serif;">- E <span style="font-family: Times New Roman,serif;">xophthalmos

<span style="font-family: arial,helvetica,sans-serif;"> <span style="font-family: Times New Roman,serif;">-Ocular muscle weakness

<span style="font-family: arial,helvetica,sans-serif;"> <span style="font-family: Times New Roman,serif;">- P <span style="font-family: Times New Roman,serif;">retibial edema

<span style="font-family: arial,helvetica,sans-serif;"> <span style="font-family: Times New Roman,serif;">- N <span style="font-family: Times New Roman,serif;">on-pitting, pruritic edema   ||

<span style="font-family: Times New Roman,serif;"> Diagnostic Testing
<span style="font-family: Times New Roman,serif;"> - Decreased TSH

<span style="font-family: Times New Roman,serif;"> - E levated free T4

<span style="font-family: Times New Roman,serif;"> - E levated T3 uptake

<span style="font-family: Times New Roman,serif;"> - E levated T3

<span style="font-family: Times New Roman,serif;"> Biomedical Treatment
<span style="font-family: Times New Roman,serif;"> - Anti-thyroid agents - propylthiouracil

<span style="font-family: Times New Roman,serif;"> - R adioactive iodine

<span style="font-family: Times New Roman,serif;"> - S urgery

<span style="font-family: Times New Roman,serif;"> **Chinese Medicine Etiology** <span style="font-family: Times New Roman,serif;"> -Internal damage of the seven emotions <span style="font-family: Times New Roman,serif;"> -Unregulated eating and drinking <span style="font-family: Times New Roman,serif;"> -Aging <span style="font-family: Times New Roman,serif;"> -Enduring disease

<span style="font-family: Times New Roman,serif;"> **Pattern Differentiation** <span style="font-family: Times New Roman,serif;"> **Qi stagnation and Phlegm Congealing** <span style="font-family: Times New Roman,serif;"> **Primary Symptoms:**   Goiter swelling in the front of the neck that is soft and not painful, possible exophthalmia <span style="font-family: Times New Roman,serif;"> **Secondary Symptoms:**   Emotional depression, frequent suspicion, irritability, easy anger <span style="font-family: Times New Roman,serif;"> **Tongue:**   Pale red, thin slimy coat <span style="font-family: Times New Roman,serif;"> **Pulse:**  Wiry (bowstring), slippery <span style="font-family: Times New Roman,serif;"> **Treatment Principles:** Course the Liver, rectify Qi, transform phlegm, scatter nodulation <span style="font-family: Times New Roman,serif;"> **Acupuncture Treatment:** LR-3, ST-40, TW-13, SI-16, LI-17, SI-17, CV-22 <span style="font-family: Times New Roman,serif;"> **Herbal Treatment:** //Xiao Chai Hu Tang + Xiao Yao San (Minor Bupleurum Decoction + Rambling Powder)// <span style="font-family: Times New Roman,serif;"> [Xia Ku Cao 15g, Mu Li 12g, Zhe Bei Mu 12g, Fu Ling 12g, Chai Hu 9g, Dang Shen 9g, Bai Zhu 9g, Dang Gui 9g, Bai Shao 9g, Kun Bu 9g, Ban Xia 9g, Chen Pi 6g, Gan Cao 6g, Da Zao 3pc, Sheng Jiang 3 slices] <span style="font-family: Times New Roman,serif;"> **Modifications:** <span style="font-family: Times New Roman,serif;"> Depressive heat + Xuan Shen 15g, Huang Qin 12g <span style="font-family: Times New Roman,serif;"> Increased appetite + Shi Gao 15g, Zhi Mu 9g <span style="font-family: Times New Roman,serif;"> Hand or finger tremors + Jiang Can 15g, Chan Tui 15g

<span style="font-family: Times New Roman,serif;"> **Liver Fire Flaring Upward** <span style="font-family: Times New Roman,serif;"> **Primary Symptoms:**   Marked goiter that is soft and not painful, possible exophthalmia <span style="font-family: Times New Roman,serif;"> **Secondary Symptoms:**   Emotional tension, irritability, impetuosity, red face, headache, dizziness, tinnitus, hand and tongue trembling, palpitations, insomnia, thirst, profuse drinking, bitter taste <span style="font-family: Times New Roman,serif;"> **Tongue:**   Red tongue, yellow coat <span style="font-family: Times New Roman,serif;"> **Pulse:**  Wiry (bowstring), rapid <span style="font-family: Times New Roman,serif;"> **Treatment Principles:** Clear the Liver and drain fire, transform phlegm, scatter nodulation <span style="font-family: Times New Roman,serif;"> **Acupuncture Treatment:** LR-2, GB-34, TW-13, SI-16, LI-17, SI-17, CV-22 <span style="font-family: Times New Roman,serif;"> **Herbal Treatment:** //Long Dan Xie Gan Tang Jia Jian (Gentiana Drain the Liver Decoction Plus Modifications)// <span style="font-family: Times New Roman,serif;"> [Xia Ku Cao 15g, Xuan Shen 15g, Sheng Di 12g, Mu Li 12g, Long Gu 12g, Ban Xia 12g, Fu Ling 12g, Zhe Bei Mu 12g, Chai Hu 9g, Huang Qin 9g, Zhi Zi 9g, Dang Gui 9g, Hai Zao 9g, Kun Bu 9g, Chen Pi 6g, Gan Cao 6g] <span style="font-family: Times New Roman,serif;"> **Modifications:** <span style="font-family: Times New Roman,serif;"> Hand or finger tremors + Shi Jue Ming 15g, Gou Teng 9g, Bai Shao 9g <span style="font-family: Times New Roman,serif;"> Fatigue + Huang Qi 20g <span style="font-family: Times New Roman,serif;"> Oral thirst, profuse drinking +Mai Men Dong 12g, Tian Hua Fen 12g <span style="font-family: Times New Roman,serif;"> Pain and distention in the eyes + Bai Zhi 15g, Gou Qi Zi 15g, Shi Chang Pu 9g, Ci Ji Li 9g

<span style="font-family: Times New Roman,serif;"> **Yin Deficiency, Yang Excess** <span style="font-family: Times New Roman,serif;"> **Primary Symptoms:**   Goiter, possible exophthalmia, possible nodulations <span style="font-family: Times New Roman,serif;"> **Secondary Symptoms:**   5 palm heat, insonia, profuse dreams, dizziness, blurred vision, palpitations, restlessness, easy sweating, hot flashes, malar flush, shaking hands, tinnitus, increased food intake but emaciation, lack of strength <span style="font-family: Times New Roman,serif;"> **Tongue:**   Red tongue, scanty coat <span style="font-family: Times New Roman,serif;"> **Pulse:**  Wiry (bowstring), fine, rapid <span style="font-family: Times New Roman,serif;"> **Treatment Principles:** Enrich Yin, subdue Yang, transform phlegm, scatter nodulation <span style="font-family: Times New Roman,serif;"> **Acupuncture Treatment:** LR-3, HT-7, KI-7, TW-13, SI-16, LI-17, SI-17, ST-9 <span style="font-family: Times New Roman,serif;"> **Herbal Treatment:** //Tian Wan Bu Xin Dan + Yi Guan Jian (Heavenly Emperor Supplement the Heart Elixir + One Link Decoction)// <span style="font-family: Times New Roman,serif;"> [Sheng Di 15g, Xuan Shen 15g, Huang Yaso Zi 15g, Mai Men Dong 12g, Tian Men Dong 12g, Gou Qi Zi 12g, Suan Zao Ren 12g, Long Gu 12g, Mu Li 12g, Fu Ling 12g, Chuan Lian Zi 9g, Yuan Zhi 9g, Wu Weri Zi 9g, Bai Zi Rren 9g, Ban Xia 9g, Hai Zao 9g, Kun Bu 9g, Chen Pi 6g, Huang Lian 3g] <span style="font-family: Times New Roman,serif;"> **Modifications:** <span style="font-family: Times New Roman,serif;"> Severe Yin deficiency + Gui Ban 12g, He Shou Wu 12g, Nu Zhen Zi 12g <span style="font-family: Times New Roman,serif;"> Severe deficiency fire +Huang Bai 9g <span style="font-family: Times New Roman,serif;"> Sudden Liver fire engendering wind +Gou Teng 15g, Jiang Can 9g <span style="font-family: Times New Roman,serif;"> leukopenia + Hu Zhang 12g, Gui Ban 12g

<span style="font-family: Times New Roman,serif;"> **Qi and Yin Dual Deficiency** <span style="font-family: Times New Roman,serif;"> **Primary Symptoms:**   Spirit lassitude and fatigue, shortness of breath,, dizziness, tinnitus, palpitations, emaciation, lack of strength <span style="font-family: Times New Roman,serif;"> **Secondary Symptoms:**   Dry rough eyes, pale lusterless complexion with possible malar flush, restlessness, insomnia, impaired memory, dry mouth and throat, possible tremors of hand and tongue <span style="font-family: Times New Roman,serif;"> **Tongue:**   Red tongue, thin or peeling coat <span style="font-family: Times New Roman,serif;"> **Pulse:**  Vacuous, rapid <span style="font-family: Times New Roman,serif;"> **Treatment Principles:** Boost the Qi, nourish Yin <span style="font-family: Times New Roman,serif;"> **Acupuncture Treatment:** BL-15, BL-18, BL-20, BL-23, TW-13, SI-16, SI-17, LI-17 <span style="font-family: Times New Roman,serif;"> **Herbal Treatment:** //Jia Kang Zhing Fang (Heavy Hyperthyroid Formula)// <span style="font-family: Times New Roman,serif;"> [Huang Qo 30-45g, Xia Ku Cao 30g, He Shou Wu 20g, Sheng Di 15g, Bai Shao 12g, Xiang Fu 12g]] <span style="font-family: Times New Roman,serif;"> **Modifications:** <span style="font-family: Times New Roman,serif;"> Bulging, distending eyes + Gou Qi Zi 15g, Bai Jie Zi 9g, Ze Xie 9g, Lai Fu Zi 9g, Di Gu Pi 9g, Ci Ji Li 9g <span style="font-family: Times New Roman,serif;"> Severe palpitations, shortness of breath + //Sheng Mai San// <span style="font-family: Times New Roman,serif;"> Yin deficiency with stirring of wind + Gui Ban 15gm Bie Jia 15g, Zhen Zhu Mu 15g

=
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 * IBIS:**

Definition:
A disease of hyperthyroidism combined with one or more of the following: pretibial myxedema, exophthalmos, and goiter. Also termed "toxic diffuse goiter" and "Grave's Disease".

Etiology:
Grave's disease: the classic cause of hyperthyroidism: is seen most in women aged 20-40. The cause is unknown although there might be an autoimmune connection, as in about 20-50% of patients there are circulating "long-acting thyroid stimulators" (LATS), which appear to be antibodies to the thyroid tissue.

Somatic therapies:
• aerobic exercise: in open air • qigong • tai qi chuan

Nutrition:
eating principles: • diet should be high caloric until normal weight has been reached and may be high in protein initially, until tissue wasting is stopped

therapeutic foods: • foods rich in Vitamin B-complex, Calcium and Phosphorus • foods that calm the Shen (Spirit), tonify the Heart, sedating foods • foods rich in Iodine, Silicon, Phosphorus: kelp, dulse, Swiss Chard, turnip greens, egg yolks, wheat germ, cod roe, lecithin, sesame seed butter, seed and nuts, raw goat milk (Jensen, p. 61)

fresh juices: • carrot juice • pineapple juice, egg yolk, wheat germ, and dulse (Jensen, p. 61) • black cherry concentrate, egg yolk, wheat germ,and chlorophyll (Jensen, p. 61) • clam juice with celery juice (Jensen, p. 53)

Botanicals
• Leonurus cardiaca: antithyroid, palpitation, tachycardia (Weiss, p. 279) • Lycopus virginicus: thyroxine antagonist, Graves' disease with cardiac involvement; dyspnea, tachycardia and tremor (British Herbal Pharmacopoeia, p. 136)

Under Graves' disease Ellingwood refers to remedies for exophthalmic goiter: • Apocynum cannabium (toxic): (Ellingwood, p. 232) • Crataegus oxyacantha: (Ellingwood, p. 219) • Echinacea angustifolia: (Ellingwood, p. 365) • Fucus vesiculosus: (Ellingwood, p. 382) • Phytolacca decandra (toxic): (Ellingwood, p. 374) • Selenicereus grandiflorus (toxic): with feeble heart (Ellingwood, p. 212) • Veratrum viride (toxic): with care, for tachycardia (Ellingwood, p. 88)

Chinese Formulae
• Xiao Luo Wan. (Yeung, p. 260; Bensky and Barolet, p. 441) • Baked Licorice Comb. (Zhi Gan Cao Tang): Qi Xu (Deficiency) with Xue Xu (Blood Deficiency): 6 g. daily for 1-3 years: irritability, insomnia, emaciation, constipation, palpitations with anxiety (Hsu, 1980, p. 529; Yeung, p. 291; Dharmananda, 1986, p. 247; Bensky and Barolet, p. 257) • Areca Seed Comb. (Hsu, 1980, p. 470; Dharmananda, 1986, p. 294) • Prunella 8 (patent) (Dharmananda, 1990, p. 77) • Gentiana C. (Long Dan Xie Gan Wan) (available as patent); Gentiana 12 (patent): Liver and Gall Bladder Invaded by Damp-Heat. (Gentiana C.: Hsu, 1980, p. 181; Yeung, p. 154; Dharmananda, 1986, p. 229; Bensky and Barolet, p. 96; patent: Zhu, p. 172; Gentiana 12: Dharmananda, 1990, p. 69)

**Acupuncture** after assessing the person and palpating, consider these patterns: Fire depletes the Heart Yin; Stagnant Qi in Liver and Spleen; Xu (Deficiency) of Yin and Flaring Up of Fire; Qi and Yin Xu (Deficiency); coagulation in Jue Yin and Xiao Yang causes soreness in the larynx (Su Wen per Requena); Phlegm, Dampness, Turbid Qi accumulated in neck; Turbid Qi External (Finkelstein)

treatment principles: loosen Liver; dispel Fire; move Xue Yu (Blood Stasis); disperse swelling

» combinations: • CV-13, GV-23, St-9, CV-19, GV-15, UB-15, Ht-7, St-10, CV-6, TW-3, Kd-7 and LI-4: influence thyroid (Worsley, 1975, p. B-20) • St-2, UB-2 and shang tian zhu: reduce exophthalmos (Lee and Cheung, p. 261) • CV-22, CV-23, LI-4 and tai yang (=): shrink thyroid gland, reduce symptoms of hyperthyroid and lower basal metabolism (Finkelstein, p. 93) • PC-5, Sp-6, qi ying and jia ji C3 through C5 (also consider Ht-6, Kd-7, shang tian zhu, PC-6, LI-4, Lv-3, Ht-7, an mian, UB-2, St-2 and GB-20) for hyperthyroidism (Shanghai, p. 603; Lee and Cheung, p. 261) • LI-18, CV-22, SI-16, St-12, Kd-27, Lu-1, CV-17, LI-4, shi xuan (bleed) and Lu-7 (needle first) for "wu-yin", i.e., five types of thyroid swelling (Lee and Cheung, p. 262) • Lu-3, TW-13 and St-11 for swelling of thyroid (Lee and Cheung, p. 262) • GB-20, GV-14, UB-11, CV-22, St-10, GV-4 and TW-3; or UB-10, GV-12, UB-12, CV-23, St-9, GV-3 and GB-26 for hypertrophy of thyroid (Lee and Cheung, p. 262) • GV-14, UB-15, GB-21, LI-11, St-36, Sp-6, CV-22, SI-14, UB-13, UB-23 and Ht-7 for swelling of thyroid (Lee and Cheung, p. 263) • CV-22, LI-17 and SI-17: promote circulation of Qi and Xue (Blood) in the neck to disperse Stagnancy (Finkelstein, p. 93) • Kd-15 <-> Kd-16, Kd-3 (posteriorly), St-2/bi tong area, "thyroid shu" (hua tuo jia ji at C6 or C7), GV-2 (D), GV-11 (D), GV-12 (D), TW-4, "thyroid helper point" and "magic point" treat thyroid imbalance (Matsumoto)

Homeopathy
• Belladonna: patient excitable, worries over trifles; violent in emotions; full pulse, rapid and bounding; throbbing in carotids; increased skin temperature; eyeballs prominent, pain deep in eyeball, pupils dilated • Ferrum phosphoricum: face flushes bright red under least excitement; rapid pulse, full and soft • Iodium: palpitation least exertion; flashes of heat all over body; profuse attacks of sweating in patient with normally dry skin; emaciation; goiter with sense of constriction; pain in larynx; loss of flesh with great hunger • Lycopus: eyes feel pushed out with tumultuous action of heart; palpitation with nervous irritation • Spongia tosta: hypertrophy of thyroid becoming increasingly hard; eyes protruding; all symptoms < mental excitement; rapid and violent palpitations; flushed

Subtle Support
• notes: D, D#, F, G, G#

• chords: diminished 8th, dominant 7th (Gimbel, p. 116)

Mind/Body
• An analysis of neuroendocrine and immunologic pathways suggests that depression, set off by bereavement, causes low levels of norepinephrine in the brain. This in turn may mediate an increase in ACTH and cortisol, leading to reductions in immune surveillance and resultant production of thyroid-stimulating globulins (TSI), and hence the development of Grave's disease in genetically susceptible (HLA B8) individuals. (Locke, 1983, p. 101-2) • Grave's hyperthyroidism, Hashimoto's thyroiditis, and exophthalmos, may each be due to closely related, inherited isolated defects in immune surveillance, presumably in suppressor T-lymphocytes. The defect in any organ-specific autoimmune disease permits the specific randomly mutating self-reactive 'forbidden' clone of helper T-lymphocytes to survive if it appears, interact with its complimentary antigen, and induce a cell mediated immune response. This clone of self-reactive T-lymphocytes would presumably expand following interaction with its antigen, and consequently direct and cooperate with appropriate groups of already present B-lymphocytes. These in turn produce specific immunoglobulins that appear to be necessary for the full expression of these disorders. The role of stress in the induction of hyperthyroidism may be by means of its effect in further reducing immune surveillance in those persons with only a partially isolated defect. Remissions may be brought about by restoring the capacity for surveillance to its previous state. (Locke, 1983, p. 102) • These patients display affects, namely higher basal levels of anxiety (trait anxiety) and of depression, which might increase their susceptibility to developing Grave's disease. A study of 37 patients suggests that a chronic high anxiety proneness could be a psychophysiological predisposing factor in the pathogenesis of Grave's, and that stressful life events (or life changes in the year previous) indeed influence its onset. (Locke, 1983, p. 130) • Hyperthyroidism: Individual feels he might lose a loved person or object, and takes care to prevent such a loss by holding on or possessiveness. (Gentry, p. 43) • Glands have the meaning of a door, or shield, or forest. Thyroid disturbance is usually associated with some issue regarding going through a door of life; making the decision of moving from one phase of life to another. (Shealy, p. 123) • Extreme disappointment at not being able to do what you want; always fulfilling others, not the self. (Hay, 1984, p. 169) • Thyroid is associated with humiliation. (Hay, 1984, p. 186) • Often associated with emotional trauma bringing it on or making it worse. (Fanning, p. 230)

Chinese psychophysiology: • Liver ~ Gan is the residence of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); reflects emotional harmony and movement; opens into the eyes; and expresses itself in the nervous system. » Healthy expressions are kindness, spontaneity, and ease of movement. » Liver Xu (Deficiency) signs include impotence; frigidity; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down. Liver Yin Xu (Deficiency) predisposes to the Shi (Excess) conditions of Liver Wind, Liver Yang Rising, and Liver Fire Blazing. » Liver Qi Stagnation reflects and accentuates emotional constraint as the Liver's function of facilitating smooth flow in the body is constricted. Stagnation is associated with frustration, irritability, tension, and feeling stuck. With time this pattern tends to produce a gloomy emotional state of constant resentment, repressed anger or depression, along with tightness in the chest, frequent sighing, abdominal tension or distension, and/or a feeling of a lump in the throat with difficulty in swallowing. (Maciocia, p. 216) » Liver Shi (Excess) signs include discontent; anger; pain in lumbar region and genitals (Seem, p. 28); muscular tension; excessive sex drive; insomnia; moodiness; excitability; genital diseases; red, tearing eyes; compulsive energy; and bitter taste in the mouth. Chronically suppressed anger can implode and give rise to Fire in the Liver and Gall Bladder with symptoms of irritability, bitter taste, headaches, etc.

• San Jiao ~ Triple Warmer regulates the relations among the three regions roughly delimited by the chest, abdomen, and pelvis; influences the supply of Xue (Blood), Qi and Fluids; is the source of Wei (Protective) Qi; and relates to the function of heat regulation. » Mental signs of Triple Warmer channel disorders include emotional upsets caused by breaking of friendships or family relations; depression; suspicion; anxiety; and poor elimination of harmful thoughts. (Seem, p. 28)

• Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; provides the "Fire of Life" through its Yang functions and tempers the Fiery qualities and activities through its Yin Watery qualities, and displays the effects of aging, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); hearing loss; fearfulness; apathy; discouragement, and scatteredness. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).