Wen | Wen SirEdit | WindbreakThyroidectomy is the main treatment for many Thyroid disease, especially thyroid cancer. Parathyroid dysfunction caused by parathyroid injury or blood supply damage is one of the common serious complications of thyroid surgery

Wen | Wen Sir

Edit | Windbreak

Thyroidectomy is the main treatment for many Thyroid disease, especially thyroid cancer. Parathyroid dysfunction caused by parathyroid injury or blood supply damage is one of the common serious complications of thyroid surgery.

According to relevant data, the incidence rate of temporary hypoparathyroidism (HP) after thyroid surgery is 7.3%~50%, while the incidence rate of permanent HP is between 1%~3%.

At present, there are very few clinical reports on the diagnosis and treatment of HP in traditional Chinese medicine. This article aims to summarize its pathogenesis and explore the traditional Chinese medicine dialectical treatment ideas for HP after thyroid surgery.

Hypoparathyroidism (HP), also known as hypothyroidism, is a series of clinical syndromes caused by insufficient secretion and/or dysfunction of parathyroid hormones.

Clinically, hyperphosphatemia, Hypocalcemia, and increased neuromuscular excitability induced by them can be seen,Ectopic calcification of soft tissue occurs.

There are no special articles or medical records in Traditional Chinese medicine to record diseases, but according to their clinical symptoms and characteristics, their H can be classified as P, which can be included in the category of "numbness", "inhumanity", "arthralgia syndrome", "spasm" and "asthenia". The most common symptoms of HP patients are numbness around the mouth and limbs.

Pathogenesis analysis of hypoparathyroidism

The occurrence of hypothyroidism after thyroid surgery is often due to surgical trauma, disconnection of blood vessels, and depletion of qi and blood, resulting in qi deficiency and blood stasis. Surgical stress, loss of liver function, liver depression and qi stagnation, and internal obstruction due to blood stasis.

Liver depression transforms into fire, liver yang is hyperactive, and fire heat consumes liver yin. Liver and kidney are of the same origin, involving kidney yin,Then the internal movement of liver wind, deficiency of liver and kidney yin, and blood deficiency of tendons.

The liver is overpowering and invading the soil, the spleen is out of circulation, and the essence of water and grain cannot be in its position. It is left to be injected into the joints and surrounding areas. Liver stores blood, liver blood deficiency, insufficient heart blood, heart liver blood deficiency.

The specific pathogenesis can be understood from the following three aspects:Qi deficiency and blood stasis are the key factors in the occurrence of postoperative HP. Separation and resection during thyroidectomy may cause accidental removal of the parathyroid gland or vascular damage, leading to damage to parathyroid function.

The radical surgery for thyroid cancer has a large scope and a long time, which is particularly prone to consuming qi and blood, leading to insufficient qi and blood. Surgery inevitably leads to damage to meridians and disconnection of blood vessels, resulting in blood stasis and stagnation of qi and blood.

Those who suffer from numbness due to deficiency of qi and cannot guide blood to nourish and nourish the muscles and meridians ", as stated in the" Principles of Medicine - Bi Men ", propose that the pathogenesis of this disease is" evil attack of lost blood ", the disease is located in the" muscles and meridians ", and the key is" numbness if not honored ".

It was pointed out that the fundamental reason for numbness lies in deficiency of qi and blood, difficulty in smooth circulation of qi and blood, stagnation of blood stasis, and inability to nourish muscles and veins, indicating that it is mostly caused by pathological changes in qi and blood.

Zhu Danxi first proposed a new viewpoint on spasms, believing that the occurrence of spasms is fundamentally caused by "deficiency of qi and blood", and it is not advisable to mistakenly use "wind medicine" to treat their style. Zhang Jingyue pointed out that "internal injury causes spasms" and emphasized that the treatment should focus on "qi and blood", emphasizing the cultivation and supplementation of qi, blood, yin and yang.

Modern medicine believes that parathyroid microcirculation disorders are an important factor causing postoperative HP.

Chen Hongyue et al. used the methods of tonifying qi and activating blood circulation, warming meridians and unblocking meridians, and modified Huangqi Guizhi Wuwu Tang to treat postoperative HP after thyroid surgery,The results indicate that this formula can significantly improve limb numbness and seizures caused by secondary hypothyroidism after thyroid surgery.

Thus, the mechanism of shortening its recovery time may be related to the role of Huangqi Guizhi Wuwu Tang in alleviating parathyroid ischemia, inhibiting platelet aggregation, and improving parathyroid microcirculation to a certain extent.

Related studies have shown that the application of Danshen Ligustrazine preparation in the treatment of HP can promote the recovery of postoperative parathyroid function.

The normal functioning of the parathyroid gland depends on the sufficient and smooth operation of qi and blood. Qi deficiency cannot generate blood and promote blood circulation, while blood stasis is caused by stagnation of blood due to blood deficiency. Qi deficiency and blood stasis are important pathogenesis of HP.

Surgical trauma stress, liver dysfunction, and postoperative HP are mostly caused by poor blood flow and internal obstruction of blood stasis, resulting in impaired parathyroid function. Depression "is the root cause of" blockage ", and" depression "is caused by the liver.

The liver is a rigid organ, responsible for ascending and active. The main function is to store blood and relieve stress, which is to regulate the whole body's qi, promote qi and blood, and regulate body fluids.

The liver, as a "general's official", is an important functional module of the body,It first responds to the stress state, and in the struggle between good and evil, the stable regulation of positive qi and pathogenic factors interact with each other.

If the lesion is within the limits of the body's compensatory capacity, the 'depression' condition is corrected and the ischemic condition is improved.If qi and blood flow are unobstructed, parathyroid function can also be restored.

HP patients have acute Hypocalcemia, muscle spasms, convulsions, and even convulsions or epileptic seizures.

On Governance

Qi deficiency and blood stasis run through the beginning and end of postoperative HP. Yiqi Huoxue is the basic treatment method in thyroidectomy, which may cause blood stasis in the parathyroid vessels, block blood circulation, and lead to temporary HP. This is often attributed to the argument of "blood stasis leading to wind".

The speed and degree of decrease in blood calcium can affect whether clinical symptoms of HP are visible after thyroid surgery.

In clinical practice, the vast majority of postoperative HP patients often experience varying degrees of numbness in the mouth, face, and limbs, accompanied by skin numbness and discomfort in the neck, neck pain, etc. Tests indicate varying degrees of decrease in PTH and blood calcium, dark red or ecchymosis of the tongue, and thin pulse strings.

The syndrome differentiation is Qi deficiency and blood stasis, and the treatment is to replenish Qi, promote blood circulation, and dissipate blood stasis.Zhang Zhongjing suggested that those whose syndromes are qi deficiency and blood stagnation, and whose battalions and guards are not in harmony, could be treated with Huangqi Guizhi Wuwu Decoction plus flavor reduction.

Astragalus membranaceus in the formula can tonify qi and blood, and is used as a monarch's medicine. When combined with cinnamon twigs, it can nourish qi and clear yang. White peony can nourish blood, astringe yin, and suppress liver yang. When combined with cinnamon twigs, it can harmonize blood and clear meridians. Ginger is fragrant and warm.

Shufeng dispelling evil, jujube nourishing qi and blood, harmonizing camp and health, with the help of Astragalus membranaceus and white peony, combined with Angelica sinensis and earth dragon nourishing blood and promoting blood circulation, oysters nourishing yin and yang, can achieve the functions of supplementing qi and blood, and unblocking meridians.

One of the important contents of the theoretical system of traditional Chinese medicine is the theory of treating from the liver, harmonizing the five viscera, and the theory of visceral signs,The argument that the liver is the "official of a general" is proposed in the "Su Wen Ling Lan Mi Dian Lun", which holds a prominent position in the theory of Tibetan phenomena.

The theory of "excessive harm and control" is an important theory of the Five Movements and Six Qi, which has been used by medical practitioners throughout history to guide clinical practice. It has developed treatment methods such as "suppressing its recovery and supporting its inability", "tonifying its mother in deficiency, and releasing its children in reality".

Hyperactivity of liver yang, burning heat damaging liver yin, deficiency of liver yin, liver regulating tendons, and loss of nourishment of tendons and veins, resulting in convulsions of hands and feet, brittle and flaccid nails,For the treatment of upper respiratory wind and spasmolysis, nourishing yin and softening tendons, a combination of Siwu Tang and Da Ding Feng Zhu is added or reduced, and white peony and licorice are reused to soften the liver and stop spasms.

Long term illness, insufficient yin and blood, qi deficiency and blood stagnation, blood stasis blocking collaterals, and addition of astragalus, salvia miltiorrhiza, chicken blood vine, etc. Due to the internal movement of the deficiency wind, the limbs are cramped and contracted, and products that nourish yin and nourish tendons are added, such as Gastrodia elata, Gouteng, papaya, etc.

Examples of Case Verification

Patient, female, 38 years old, initially diagnosed on April 15, 2021. Chief complaint: After undergoing total thyroidectomy for thyroid cancer, limb numbness occurred for 2 months and worsened with limb convulsions and pain for 1 day.

Symptoms: mental fatigue, restlessness, stiffness in the lips and face, wrist spasms, soreness in the lower back and knees, and absence of precordial pain,The tongue has a pale coating and a heavy pulse. Check: Blood calcium is 1.77mmol/L, PTH is 5.3pg/ml.

Traditional Chinese Medicine Diagnosis: Spasm Syndrome: Liver and kidney yin deficiency, liver yang hyperactivity. The treatment involves calming the liver and calming the wind, nourishing yin and suppressing yang.

Fang Gui Zhen Gan Xi Feng Tang with added or reduced formula: 20g each for Huai Niu Xi and Huai Shan Yao, 30g each for raw dragon bone and oyster (decocted first), 15g each for white peony, raw rehmannia, and turtle shell, 10g each for black ginseng, ophiopogon japonicus, angelica, and cornus, and 5g each for roasted licorice.

1 dose per day, boiled in water. On April 22, 2021, during a follow-up visit, there was no recurrence of limb convulsions and no significant numbness. Keep taking it for another month.

Note: After surgical treatment for thyroid cancer, the patient's limbs become numb, and their symptoms gradually worsen, leading to symptoms such as convulsions and spasms.

Surgical meridian disconnection, traumatic stress, etc. can lead to stagnation of qi and blood, loss of liver function, internal movement of liver wind, stagnation of liver qi into fire, hyperactivity of liver yang, depletion of liver yin, deficiency of liver and kidney yin, yin deficiency, wind movement of muscles and veins, and limb numbness and convulsions.

Therefore, the treatment is to calm the liver and calm the wind, nourish yin and suppress yang. The bitter and sour taste of Achyranthes bidentata in the formula is good for tonifying the liver and kidney, and promoting blood circulation. Oysters and dragon bones can soothe the nerves, calm the heart, calm the liver, and nourish the yang. The turtle shell is salty and flat, enters the liver and kidneys, nourishes yin and conceals yang.

Angelica sinensis is spicy and warm with a thick taste, nourishing blood and liver, nourishing yin without stagnation. Radix Rehmanniae and Radix Paeoniae Alba nourish yin and nourish blood. Yam and Ophiopogon japonicus nourish the yin of the lungs and stomach. One is to clear gold and make wood, and the other is to cultivate soil and honor wood.

Xuanshen enters the Kidney Meridian of Foot Shaoyin, which can cool blood and nourish yin. It is a holy herb for treating the dense qi in the air. Combined with the glans penis and white peony, it can nourish liver yin and soften liver qi. The whole recipe plays the role of calming the liver, calming the wind, nourishing yin and suppressing yang, thus it can dispel wind, spasms, and stop symptoms.

Boil the entire set of medicinal herbs into a soup, and the liquid is acidic, which is conducive to the dissolution of calcium salts in the dragon bones and oysters in the soup. The acidic soup can also increase intestinal acidity.

The acidic environment in the intestine can promote the absorption of calcium by the intestine. The management of postoperative HP patients with thyroid cancer has its unique characteristics.

(1) Poor patient function and tolerance: Surgical trauma can have a certain impact on the patient's physical tolerance. Therefore, when choosing an appropriate treatment plan, it is necessary to fully consider the impact of surgical surgery on patients after surgery.

(2) There are higher requirements for the efficacy and safety of treatment plans: unlike patients with primary HP, patients with postoperative HP in thyroid cancer are in the perioperative period. If the selected treatment plan has safety hazards, it will increase the patient's physical load and affect the prognosis.

The advantages of combining traditional Chinese medicine syndrome differentiation to treat postoperative HP in thyroid cancer include: fully matching the patient's pathogenesis:From the perspective of traditional Chinese medicine, surgical procedures can cause certain harm to the human body, leading to dysfunction of the functions of qi, blood, meridians, and even organs.

The application of the treatment methods of "tonifying the deficiency" and "reducing the deficiency" can promote the overall recovery of the human body, reflecting the medical concept of the "seeking balance" ecological system.

Obvious therapeutic effect: Compared with the simple Western medicine treatment method aimed at correcting blood calcium, combined with traditional Chinese medicine syndrome differentiation treatment, it can gradually restore the patient's physiological state of sufficient qi and blood, and harmony of the five organs after surgery.

To alleviate various symptoms caused by hypothyroidism.Improving the quality of life of patients: During the recovery period, patients may experience multiple system symptoms such as neurological and digestive symptoms due to decreased parathyroid function.

As a result, the quality of life of patients decreases, and the "holistic view" of traditional Chinese medicine helps to effectively improve symptoms and improve quality of life.

In summary, the main pathogenesis of postoperative HP after thyroid surgery is qi deficiency and blood stasis, as well as imbalance of the five organs. The treatment is to replenish qi and promote blood circulation, harmonize the five organs, and the severity of the condition varies.

The duration of the disease is different. Based on the Symptomatic treatment of western medicine, the application of traditional Chinese medicine based on syndrome differentiation can improve the quality of life of patients after surgery.

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