Subacute thyroiditis
Subacute thyroiditis, also known as granulomatous or giant cell thyroiditis, is generally considered to be caused by viral infection, accompanied by fever and other symptoms of viral infection. Mumps, measles and influenza viruses have been isolated, and painful nodules appear in the thyroid gland, with a course of 6 weeks to half a year, and then heal themselves. This disease is more common in women than in men, and usually occurs around the age of 30.
Visually, the thyroid gland is uneven, slightly swollen and hard, and often adheres to the surrounding area. Gray necrosis or fibrosis can be seen on the section. Microscopically, irregular follicular necrosis and rupture, accompanied by acute and subacute inflammation, will form granuloma similar to tuberculosis nodules. The center of granuloma is an irregular colloidal fragment of foreign body giant cell reaction, surrounded by macrophages and lymphocytes. After granuloma fibrosis, a small amount of lymphocytes infiltrated. In the early stage of the disease, thyrotoxicosis may occur due to the destruction of follicles and the increase of thyroxine release; If the thyroid gland is seriously damaged or even fibrotic in the later stage, hypothyroidism may occur.
(ii) Chronic thyroiditis
1. Chronic lymphocytic thyroiditis, also known as Hashimoto thyroiditis, is an autoimmune disease. The patient has goiter and hypofunction. Thyroid structure was replaced by a large number of lymphocytes and macrophages, follicular atrophy and connective tissue proliferation. The basic defect of the disease is that antigen-specific T inhibits the decrease of cells, which makes cytotoxic T cells attack and destroy follicular cells, and Th cells participate in the formation of autoantibodies by B cells, causing autoimmune reactions.
2. Fibrous thyroiditis, also known as Riedel's goiter, is relatively rare, mainly occurring in middle-aged women, and the cause is unknown. The lesions mostly start from one side, the thyroid gland is hard, the surface is slightly nodular, and it is obviously adhered to the surrounding area, and the section is gray. Microscopically, thyroid follicles were obviously atrophied, fibrous tissue was obviously proliferated and glassy, and a small amount of lymphocytes infiltrated. Clinical hypothyroidism is common.
thyroadenitis
First, acute suppurative thyroiditis is treated with effective antibiotics, and abscess can be punctured or cut and drained.
Second, subacute thyroiditis is treated with corticosteroids, thyroid tablets, indomethacin and other anti-inflammatory and analgesic drugs according to the situation.
Three, chronic lymphocytic thyroiditis:
1, treated with thyroid tablets or sodium thyroxine.
2. Hyperthyroidism patients can take antithyroid drugs and thyroid tablets at the same time.
3. Patients with obvious goiter or compression symptoms can be treated with corticosteroids for a short time.
4. If the above-mentioned compression symptoms are obviously ineffective after treatment, surgical treatment can be considered.
Four, chronic aggressive fibrous thyroiditis, surgical treatment when necessary.
Nonspecific chronic thyroiditis
First, chronic lymphocytic thyroiditis is generally treated by non-surgery. Thyroid tablets can be taken for a long time, and adrenocortical hormones can also be added. Only when a few advanced cases have symptoms of anterior cervical compression can the isthmus of thyroid be surgically removed.
Second, chronic aggressive fibrous thyroiditis, when there are compression symptoms in the late stage, the isthmus of thyroid can be removed or partial thyroidectomy can be done, and thyroid preparations can be given after operation.
Three, complicated with cancer or dysfunction, respectively, according to hyperthyroidism, hypothyroidism or thyroid cancer treatment.
Treatment of subacute thyroiditis with traditional Chinese medicine
Subacute thyroiditis (referred to as methylene inflammation) is more common in adults aged 30 ~ 50, and the incidence rate in women is higher than that in men. It is generally believed that this disease is related to viral infection, because most patients are secondary to influenza. Mumps and other viral infections. The clinical symptoms of this disease are quite different, such as rapid enlargement of thyroid gland and severe pain, but the systemic symptoms are not obvious; Due to the sudden onset, the systemic symptoms are particularly serious, and some people ignore the local symptoms and signs of the thyroid gland, so this disease can easily lead to misdiagnosis or missed diagnosis.
The typical acute methylene inflammation attack is more sudden, accompanied by chills and fever. Upper respiratory symptoms such as sore throat. The most typical manifestations are goiter and pain. Swelling and pain can start from one side, then spread to the other side, and then involve the whole thyroid gland, or goiter changes, and the diseased gland is hard and can move up and down with swallowing. The local pain of thyroid gland is manifested as conscious pain. Radiation pain and tenderness are obvious. There is no enlargement of the surrounding lymph nodes, and when the pain is severe, it can radiate along the neck to the mandible. When chewing, swallowing, eating, coughing, turning the neck or bowing, the pain behind the ear, pillow, gums, chest and back is aggravated. At this time, most patients still have hyperthyroidism symptoms, such as palpitation, fear of heat, sweating, overeating and so on. Frequent defecation, weight loss, mental stress, irritability, shaking hands, etc.
When the disease enters remission stage, goiter and pain are gradually relieved, and patients often have hypothyroidism, such as fatigue and weakness. Sleepiness, fear of cold, love warmth. Pale face, loss of appetite, abdominal distension, constipation, edema, weight gain, etc. This is because thyroid cells are destroyed by inflammation and thyroid hormones are consumed.
For a long time, the accepted treatment for methylene inflammation is taking adrenocortical hormone, such as prednisone. However, practice has proved that hormones can not change the course of methylene inflammation, but can cover up the symptoms. If the drug is stopped early or the dosage is reduced quickly, the condition will be repeated and the recovery time of thyroid gland will be prolonged. The greater the dose of hormone, the longer the medication time, and the more obvious its side effects.
After many years of clinical practice, we found that Chinese medicine has an outstanding effect in treating methylene inflammation. After a definite diagnosis, we adopt different treatment rules according to different stages of disease development, and carry out dynamic treatment. It is the key to improve the curative effect of traditional Chinese medicine to adopt the method of "treating the same disease with different treatments" in treatment. The sooner you use Chinese medicine, the sooner the curative effect will be better. For patients who have recurring episodes of dichloromethane after taking prednisone, they can stop taking hormones and treat them with traditional Chinese medicine. After years of long-term observation, no recurrence was found in patients with methylene chloride cured by traditional Chinese medicine.
Reference: www.zgxl.net.