Based on its main clinical manifestations, it is classified under the categories of "fatigue disease" and "deficiency fatigue." The disease etiology and mechanism are as follows: prolonged mental depression, emotional distress, and liver disharmony lead to liver qi depression, qi stagnation, and blood stasis. If liver qi depression persists for a long time, qi depression transforms into fire, scorching yin fluids, resulting in yin deficiency with internal heat or ascendant hyperactivity of liver yang. If the condition persists for a long time, yin deficiency gradually damages yang, leading to spleen-kidney yang deficiency.

bubble_chart Modern Research

Hashimoto's thyroiditis, also known as chronic lymphocytic thyroiditis, is an autoimmune disease. This condition is more common in middle-aged women and is also a frequent cause of sporadic goiter in children. The onset is slow and insidious, often discovered incidentally as an enlarged thyroid, typically 2 to 8 times the size of a normal thyroid. Initially, thyroid function is normal, sometimes accompanied by hyperthyroidism, but in the advanced stage, as the thyroid is destroyed to a certain extent, many patients gradually develop hypothyroidism, with a few presenting with myxedema, sometimes accompanied by pernicious anemia.

Modern medicine believes that the pathogenesis of this disease is likely related to autoimmune disorders and genetic defects. Currently, seven antibodies have been identified in the serum: TGA, TMA, thyroid cell membrane, T₃, T₃, and TSI, some of which are involved in the destruction of thyroid follicles and the disease process. Further elucidation shows that cell-mediated immunity is involved in this disease, with activated K cells exerting cytotoxic effects, leading to permanent destruction of self-thyroid cells. Additionally, genetic predisposition and immune surveillance dysfunction may also be the basis for the occurrence of autoimmune reactions.

Any middle-aged woman with a firm, diffuse, symmetrical thyroid enlargement, regardless of thyroid function status, should be suspected of having this disease.

Laboratory tests

1. Serum TGA: 70% to 80% of patients show a positive reaction.
2. Serum TMA: More than 90% of patients show a positive reaction.
3. Perchlorate discharge test: Mostly shows a positive reaction.
4. Thyroid fine-needle aspiration biopsy: This method is helpful for definitive diagnosis in suspected cases.

bubble_chart Pattern Analysis

1. Liver Qi Depression︰A goiter under the neck, firm in texture, painless, and movable with swallowing. In the early stages, there may be no typical symptoms, or only signs such as emotional depression, irritability, aversion to heat, etc. Later, symptoms like chest and hypochondriac distension, profuse sweating, palpitation, and flusteredness may appear. The tongue is red with thin yellow coating, and the pulse is wiry and rapid. The treatment involves soothing the liver and regulating qi, resolving phlegm, and dispersing nodules. Modified Bupleurum Liver-Soothing Powder or Peripatetic Powder can be used. Ingredients include Bupleurum 10g, Red Peony Root 10g, Poria 15g, Sichuan Lovage Rhizome 6g, Submature Bitter Orange 10g, Cyperus 10g, Chinese Angelica 10g, and Prepared Liquorice Root 6g. For pronounced goiter, add Chinaberry Fruit and Prunella. For cases accompanied by mental depression, dysphoria, or insomnia, add Milkwort Root and Sour Jujube. For palpitation and flusteredness, increase the dosage of Prepared Liquorice Root to 15g and add Asparagus Root and Ophiopogon Tuber.
2. Yin Deficiency︰A painless, firm swelling under the neck, accompanied by mental tension, restlessness, insomnia, tidal fever, night sweats, seminal emission in men, scanty menstruation or amenorrhea in women, or bright eyes, hand tremors, palpitations, a red tongue with little moisture, and a thin, rapid or wiry, thin, rapid pulse. This type is relatively rare. The treatment involves enriching yin and clearing heat, softening hardness, and dissipating masses. Modified Lycium and Rehmannia Decoction is used: Barbary Wolfberry Fruit 15g, Chrysanthemum Flower 10g, Unprocessed Rehmannia Root 15g, Moutan Bark 10g, Cornus Fruit 10g, Poria 10g, Chinese Yam 25g, Ophiopogon Tuber 10g, Solomonseal Rhizome 20g. For severe deficiency fire, add Anemarrhena and Phellodendron Bark. For significant neck swelling, add Tortoise Carapace, Prunella, and Oyster Shell. For frequent seminal emission, add Cherokee Rose Fruit and Gordon Euryale Seed.
3. Spleen-kidney Yang Deficiency︰Swelling under the neck, pale complexion, aversion to cold with cold limbs, soreness and weakness in the lower back and knees, dizziness with blurred vision, impotence in men, or scanty sperm and cold sperm, hypermenorrhea with pale discharge or amenorrhea in women, clear and cold leukorrhea, or dull expression, facial puffiness, and limb edema. The tongue texture is pale with white, slippery or greasy coating, and the pulse is deep, thin, or deep, thin, and weak. This type is the most common. Treatment involves warming and tonifying the spleen and kidney. For cases with kidney yang deficiency, the Golden Chamber Kidney Qi Pill is selected: - Prepared Aconite Lateral Root 10g - Cassia Bark 10g - Prepared Rehmannia Root 15g - Cornus Officinalis 10g - Chinese Yam 15g - Poria 10g - Moutan Bark 10g - Alisma 10g For cases with spleen and kidney deficiency, the Right-Restoring Pill with modifications is selected: - Prepared Rehmannia Root 15g - Chinese Yam 15g - Cornus Officinalis 10g - Barbary Wolfberry Fruit 10g - Cassia Bark 10g - Eucommia Bark 10g - Dodder Seed 15g - Cervi Deer-Horn Glue 10g (melted) - Dried Ginger 10g - Prepared Liquorice Root 5g Modifications: - For shortness of breath, fatigue, and listlessness, add Astragalus Root and Codonopsis. - For fear of cold, soreness, and coldness in the lower back and knees, add Chinese Taxillus Herb and Epimedium Herb. - For facial puffiness and limb edema, remove Prepared Liquorice Root and increase the dosage of Poria and Alisma. - For deficiency of both qi and blood, the Ten Major Tonics Decoction may be used.