TCM Chapter III.13.

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Chapter III/13

Written by Dr Szilard Hamvas (chapters are translated from my book published in Hungarian)

Overactive Thyroid – Case Study

Zsanett D., 41 years old

 

1.) Anamnesis, main complaints

The patient came to my surgery complaining of thyroid dysfunction. In October 2008, one year before she applied for treatment, she underwent Thyroid Scintigraphy. This verified diffuse goitre, indicating an overactive thyroid.  The values of antibodies (TRAK, AntiTPO) support the diagnosis of hyperthyreosis syndrome.   

The table below sums up the changes in thyroid hormone levels:

Date	TSH (mU/l)	FT4 (pmol/l)	Diagnosis	Applied therapy
Reference value	0.3-3.6	10.3-21.9
Sept 2008	0.01	5.52	Hyperthyreosis	Starting values
Nov 2008	0.014	0.95	Hyperthyreosis	Metothyrin Varying doses
Feb 2009	71.3	0.48	Iatrogenic Hypothyreosis	Metothyrin STOPPED
Mar 2009	0.036	2.59	Hyperthyreosis	Metothyrin  ½ tablet
Apr 2009	0.01	20.70	Hyperthyreosis	Surgery recommended

Table 13/1

 

As her thyroid hormone levels had not normalised within nine months, her doctor suggested surgery. It was then that she decided to give alternative therapy a try.

 

She had been bodybuilding since she was 14 years old. In 1992 she terminated her pregnancy at the demand of her common-law husband. She became pregnant again in 1994 (spontaneous pregnancy), then gave birth at week 27 via caesarean section, due to complications in the pregnancy.  The child died four days after. After that her marriage deteriorated and she got divorced. She married again in 2007 and tried artificial insemination, which was unsuccessful.  Her second marriage did not work. Her husband did not spend much time with her, and she carried the financial burdens by herself. She exhausted herself worrying about what her next step should be.

 

Previously she had suffered from a gastric ulcer for years. A year ago (in the summer of 2008) she contracted infectious mononucleosis, which resulted in joint and muscle pain, skin troubles, enlargement of the liver and spleen, and difficulty in breathing (EB-CMV serology positive).

 

Family anamnesis: her father developed a malignant tumour, which according to the patient’s testimony metastasized in the thyroid gland.

 

2.) Complaints and symptoms (May 2008) 

Heat waves, perspiration
Shortness of breath
Tachycardia
Dizziness
Hair loss
Eyes frequently bloodshot
Explosive personality
Grinding of teeth
Acne with yellow purulent content
Sensitive knees Sensitive lower back (L4-5 disc protrusion)
Nasal discharge while at work
Numbness of right hand while working
Lower extremity oedema while at work
Frequent pain in her left kidney
Body building since the age of 14
Fertility problems
Previous ulcer
Pulse:  Right: xi, Kidney: xu.             Left: xian. Kidney: xi.
Tongue: indented, purplish pink. Coating: thin and white

Table 13/2

She worked as a masseuse.  When she massaged sensitive areas of her patients, her nose started to run.

 

 3.) Diagnostic interpretation of complaints:

Heat waves, perspiration	Heart Yin deficiency
Shortness of breath	Lung Qi deficiency/ Lung Qi Stagnation
Tachycardia	Heart Yin deficiency/ Heart Fire
Dizziness	Liver Yang Rising / Kidney Yang deficiency
Hair loss	Kidney Yang deficiency/ Blood deficiency
Eyes frequently bloodshot	Liver Fire/Liver Yang Rising
Explosive personality	Liver Fire
Grinding of teeth during sleep	Liver Fire
Acne with yellow purulent content	Damp Heat in the upper region
Sensitive knees Sensitive lower back (L4-5 disc protrusion)	Kidney deficiency
Nasal discharge while at work	Kidney Qi deficiency
Numbness of right hand while working	Local Blood deficiency (its background is either Qi Stagnation or blockage due to Phlegm)
Lower extremity oedema while at work	Kidney-Spleen Yang deficiency
Frequent pain in her right kidney	Kidney Qi deficiency
Body building since the age of 14	Weakens Kidney
Fertility problems	Kidney deficiency
Previous ulcer	Stomach Heat (probably Liver-Stomach disharmony)
Pulse:  Right: xi, Kidney: xu.              Left: xian. Kidney: xi.	Spleen Qi deficiency, Kidney Yang deficiency Liver Qi Stagnation, Kidney Yin deficiency
Tongue: indented, purplish pink. Coating: thin and white.	Spleen Qi deficiency, Qi-Blood stagnation

Table 13/3.

4.) Differential diagnosis and etiopathogenesis:

In this case the energetic disturbances in the background of the hyperthyreosis are the Liver Fire and the Heart Fire. The Heart Fire is generated by the Liver Fire.  (Her previous gastric ulcer could well have originated from the Liver, but at that time the Liver caused disharmony inside the Middle Burner. Now it is the Liver as Mother making its Child the Heart ill.)

The additional important energetic disturbance is the Kidney Qi deficiency, which could have been caused by patient starting bodybuilding at an early age and also by her abortion. Because of the Kidney Qi deficiency the upward flow of the Kidney Yin and Jing has been weakened so the Kidney Yin is unable to quench either the Liver Fire or the Heart Fire. On the other hand, if the Liver and Heart Fire are artificially extinguished by giving the patient Metothyrin, the Kidney and Spleen deficiency, that were kept hidden by the surface Fire Excess, will come into the foreground. This will manifest itself in hypothyreosis. For this reason it is extremely difficult to normalize thyroid function.

 

Breathlessness is also related to the Liver. The Liver rebels against the control of the Lung. These symptoms carry a message in psychological terms as well.

 

An overactive thyroid gland makes faster work and higher performance possible. The patient suffers from the fact that she has to struggle for her financial well-being on her own. She carries the burdens by herself, so it is no wonder that her lower back hurts. She worries a lot and often gets angry, which is reflected in the fact that she grinds her teeth in her sleep. The Liver Fire is clearly related to her anger stemming from her present situation. (The patient can see this herself, and she is asking for psychotherapy in order to help her change).

(An interesting complaint of hers is her runny nose while working. This only occurs when she massages sensitive areas of her patients’ bodies. It is possible that when she reaches energy deficient areas during the massage, her patients drain her of her energy. Her Kidney Qi may be at a point where a small energy loss is enough to prevent the Kidney Qi flowing upward in the Governing meridian and reaching the nose where it controls the circulation of the fluid). This manifests itself in the runny nose.

 

 

5.) Therapeutic aims

Thyroid function control
Eliminate Heart Fire Restore Heart-Kidney harmony Pacify Shen
Pacify Liver Fire, harmonise Liver
Support Kidney Qi
Elevating Kidney Jing to head
Strengthen Spleen,  dissolve Phlegm

Table 13/4.

Note to Table 13/4:

The root of the problem in this case of hyperthyreoses is the Liver Fire and Kidney Qi deficiency. In this case of hypothyreoses it is Kidney Qi deficiency. It follows that in order to solve this problem it is essential to tonify the Kidney Qi alongside the treatment of the Liver Fire. The treatment of the Heart Fire is only important in the beginning of the therapy, and it is not absolutely necessary to harmonize the Lung Qi. The treatment of the manifestation is only important if it causes unbearable symptoms for the patient.

I find the treatment of the Spleen important, even though it is only slightly affected, since the Kidney and the Spleen support each other (The postnatal helps the prenatal.)

 

6.) Therapeutic aims and possible acupuncture points

Thyroid function control	TE13, LI18, LI11, L14 (harmonizing)
Eliminate Heart Fire Restore Heart Kidney harmony Pacify Shen	P7 (-) H6 (-), K7 (+), B52-B44 (+) Cv15-ExHN3 (harmonizing)
Pacify Liver Fire, harmonise Liver	Liv2 (-), Liv3-P6, Liv3-G34, Liv14-B18, Sp6 (+)
Support Kidney Qi	K3, K7, Cv4, Gv20, B23 (+)
Elevating Kidney Jing to head	Cv4, Gv24 (+)
Strengthen Spleen,  dissolve Mucus	St36, Sp3 (+), St40 (-)

Table13/5.

Note to table13/5.:

TE13 is an empirical point; LI18 is a local point in the treatment of thyroid problems.

Liv3-Liv2: Applying the Yuan and Child points together reducing the Excess of the Zang organ that belongs to the given meridian, according to the “Cleaning the Source” rule. (Applying the Yuan and Mother points together will according to the “Tonifying the Source” rule tonify the Zang organ that belongs to the given meridian.)

 

  

7.) Realised treatment step by step, results

 First and second treatment:

Thyroid function control	TE13, LI18, LI11, LI4
Eliminate Heart Fire Pacify Shen	P7 (-) Cv15-ExHN3
Pacify Liver Fire, harmonise Liver	Liv3, Liv2 (-)
Support Kidney Qi	K3, Cv4, Gv20
Strengthen Spleen	St36

Table 13/6.

 

She gradually came off the Metothyrin!

 

Results after the second treatment: She hasn’t been taking Metothyrin for three days. She is very tired. She also has severe pain around her lower back. Acnes with yellow purulent contents appear on her chin. Opinion: Spleen-Kidney Qi deficiency. Damp Heat in the upper body.

 

Third treatment, adjustment to therapy:

St40 and St44 were added to LI4: Bring down Dampness-Heat-Phlegm from the face.

Because St40 had been made part of the point combination I used Sp3 instead of St36. (Sp3-St40: Yuan-Luo points, used according to the Host-Guest rule.) 

As the symptoms of the Liver and the Heart have alleviated I applied Liv3-P6 points instead of Liv2-P7. I complemented these with K7-H6 points because of the perspiration caused by Heart Yin deficiency.

 

Result after the third treatment: The patient is feeling better. She is not tired, and her spots come and go. Opinion: the next thing to do is to elevate Yin to her face in order to clear Heat.

 

Fourth treatment, adjustment to therapy: alongside Cv4, apply Gv24 instead of Gv20. This promotes the Kidney Essence (Jing) getting to the head.

 

Result after the fourth treatment: The patient became depressed and tachycardic. She developed cramps in her neck and lower arms. Opinion: The cause of depression can be Liver Qi Stagnation or Kidney Deficiency. Changing the Gv20 was probably premature. (The Gv20 helps the upward flow of the Kidney Qi.)

The tachycardia implies that the Liver Fire and the Heart Fire needs further clearing. It was too early to leave out the L2-P7. The muscle cramps may point to Wind originating from Liver Fire.

 

Fifth- sixth treatment, adjustment to therapy: Leaving off K7-H6, instead Liv14, Liv3, Liv2 (-) and Sp6. The Sp6 harmonizes the Liver, and as a Yin mover it helps clearing the Liver Fire. Because of her depression I applied Gv20 instead of Gv24. I stopped the point St40 because I decided I would not deal with the spots for the moment. As well as keeping Sp3 I put the St36 point back into the prescription.

 

Control thyroid function	TE13, LI18, LI11, LI4
Pacify Shen	Cv14-ExHN3
Pacify Liver Fire, Harmonise Liver	Liv14, Liv3, Liv2 (-), Sp6
Support Kidney Qi	K3, Cv4, Gv20
Strengthen Spleen	Sp3, St36

Table 13/7

Note to Table 13/7:

Because of the muscle cramps I considered the Hui point of the sinews (G34), but I hoped that pacifying the Liver Fire would solve the problem.

 

Result after the sixth treatment: No complaints.

 

The table below shows the results of the hormone test after the sixth treatment:

Date	TSH (0.3-3.6)	FT4 (10.3-21.9)	Diagnosis	Applied therapy
July 2009.	0.58	14.8	Euthyreosis	Acupuncture

Table 13/8

 

Seventh to tenth treatment, adjustment to therapy:

I have slightly changed the therapy, I simplified it: I left out points Sp3, Liv14 and Cv14-ExHN3. To move Kidney Yin to the head I added K10, B10 points to the prescription.

 

The following table shows the applied prescription from the seventh to the tenth treatment:

Thyroid control	TE13, LI18, LI11, LI4
Pacify Liver Fire, harmonize Liver	Liv3, Liv2(-), Sp6
Support Kidney Qi Bring Kidney Yin to the head	K3, Cv4, Gv20, K10-B10 (+)
Strengthen Spleen	St36

Table 13/9

  

Note to Table 13/9:

K10 is the Sea point of the Kidney meridian and Water points of the meridian, it tonifies Yin. It is the last point before the Kidney meridian’s Jing Bie departures. Kidney Jing Bie and Urinary bladder Jing Bie meridians are united in B10; it is “Window to the Sky” point as well: it brings up Yin to the head.

 

Until the seventh treatment the patient has weekly treatments. After that we make the treatments less frequent, and she starts coming fortnightly.

 

8.) Summary:   

The table below shows the results of the hormone tests carried out after the first ten treatments:

  

Date	TSH (0.3-3.6)	FT4 (10.3-21.9)	Diagnosis	Applied therapy
April 2009	0.01	20.70	Hyperthyreosis	Before acupuncture
July 2009	0.58	14.8	Euthyreosis	Acupuncture
September 2009	1.06	13.8	Euthyreosis	Acupuncture

 

Without medication! The patient continues to be complaint free.

 (We continued the treatments after this for several more months while further reducing their frequency.)