The general measures of comprehensive treatment of traditional Chinese and western medicine have no clear treatment method for the cause of this disease. Patients should avoid mental stress and other unfavorable factors, pay attention to proper rest and take enough calories and vitamins to supplement the consumption caused by this disease. The main purpose of treatment is to control hypermetabolic syndrome and promote the normalization of immune monitoring. Western medicine treatment 1. Indications of antithyroid drugs (1): It is suitable for patients with mild symptoms and mild to moderate goiter; ② Teenagers, children and elderly patients under the age of 20; ③ Pregnant women; ④ Recurrence after subtotal thyroidectomy is not suitable for I131; ⑤ preoperative preparation or as an auxiliary means of I 13 1 treatment. Commonly used are methyl or propyl thiouracil, tabazole and hyperthyroidism. (2) Dosage and course of treatment: The general course of treatment is 1.5 ~ 2 years, but there are great individual differences. At the initial stage, the dosage of tabazole or hyperthyroidism is 30 ~ 40 mg per day. After 6 ~ 8 weeks, if the symptoms are obviously improved, the weight is increased, the heart rate is reduced to 80 ~ 90 beats/min, and T4 or T3 is close to normal, the dosage can be reduced by 5mg every 2 ~ 3 weeks according to the illness. In this process, pay close attention to the condition and try to maintain the normal and stable thyroid function. The drug reduction stage generally lasts for 2 ~ 3 months, and gradually transitions to the maintenance stage. The daily dose in maintenance period is 5 ~ 10 mg, and it can be reduced to 2.5 ~ 5 mg before stopping the drug, about 1 ~ 1.5 years or even longer. (3) Precautions for treatment ① Avoid intermittent medication during treatment. In case of stress, the dosage should be increased as appropriate, and then decreased after it is stable. ② agranulocytosis may occur after medication, especially in patients treated with methylthiouracil. The white blood cell count and classification should be rechecked every 1 ~ 2 weeks in the initial stage, and every 2 ~ 4 weeks in the decrement and maintenance stage. If the count is less than 4× 10 * 9/L, prednisone can be taken orally under close observation, and if it continues to be less than 3× 10 * 9/L, the drug should be stopped. Other side effects may occur after taking the medicine, such as drug eruption, elevated serum ALT, joint pain and gastrointestinal symptoms. , should be treated accordingly or replace the antithyroid drugs used. (4) Adjuvant drug therapy: ① During the initial 1 ~ 2 months of antithyroid drug therapy, propranolol 10 ~ 20 mg, three times a day, can improve symptoms such as palpitation, tachycardia, nervousness, tremor and hyperhidrosis. ② At the beginning of the drug reduction period, a small dose of dry thyroid preparation tablets can be added, and the daily dose is 0.03 ~ 0.06 or 50 ~ 100μ g thyroxine, so as to stabilize the coordination of hypothalamus-pituitary-thyroid axis and avoid the aggravation of goiter and exophthalmos. 2. Radioactivity I 13 1 therapeutic indications (1): suitable for people over 25 years old; ② Patients who are allergic to antithyroid drugs can't continue to use them, or those who are ineffective after long-term treatment, or those who relapse after stopping taking drugs; ③ Recurrence after subtotal thyroidectomy; ④ Patients with heart disease, diabetes and severe liver and kidney diseases who cannot be operated; ⑤ Hyperthyroidism with exophthalmos. (2) Contraindications: ① Pregnant or lactating women; (2) people under the age of 25; ③ Patients with active liver and kidney diseases; ④ The total number of cells is less than 3×10× 9/L; ⑤ Patients with severe hyperthyroidism; ⑥ Nodules are swollen with hyperfunction, and the nodules are "cold nodules". (3) Treatment methods and dosage: The dosage is usually determined with reference to thyroid weight and maximum absorption rate131i. The formula is: I 13 1 dose mbq (μ ci) = 2.6 ~ 3.7mbq (70 ~100μ ci) × thyroid weight (g)/ thyroid maximum absorption rate I 13 1 It must be adjusted according to the patient's age, illness, previous treatment and the effective half-life of I 13 1 in thyroid. ②I 13 1 Avoid using all kinds of iodine-containing foods and drugs 2-4 weeks before treatment. If the condition is serious and the heart rate exceeds 120 beats/min before treatment, antithyroid drugs or propranolol should be used first. After the symptoms were controlled, the drug was stopped for 2 to 3 days, and I 13 1 was taken before I 13 1. After taking I 13 1 1 ~ 2 weeks, antithyroid drug treatment can be resumed. ③ The long-term complication of131I in the treatment of hyperthyroidism is hypothyroidism. Generally speaking, it is not considered that this therapy will increase the total incidence of cancer, but because patients of old age are sensitive to ionizing radiation, it is prudent for adolescent patients under 25 to choose other treatment methods. 3. Indications for surgical treatment (1): Indications for surgical treatment are: ① obvious enlargement of thyroid gland and oppression of adjacent organs; ② The thyroid gland is large, and antithyroid drugs are ineffective or relapse after stopping taking them; ③ Nodular goiter with hyperthyroidism; ④ Thyroid gland behind sternum; ⑤ Those who can't insist on taking medicine for a long time and want to control their illness quickly. (2) Precautions for treatment: High exophthalmos may be aggravated after operation, so it is listed as a taboo. Patients were controlled by antithyroid drugs before operation, and their heart rate recovered to below 80 ~ 90 beats/min, and then propranolol or propranolol combined with iodide were used for preoperative preparation. Surgery may cause local bleeding, damage recurrent laryngeal nerve, superior laryngeal nerve and thyroid gland, aggravate exophthalmos and permanent hypothyroidism. Traditional Chinese medicine treatment of hyperthyroidism is mainly based on syndrome differentiation and classification. The evolution of hyperthyroidism syndrome types has such a law: liver depression and phlegm coagulation are the main symptoms in the early stage of onset, and the treatment should be based on regulating qi and resolving phlegm, softening hard mass and resolving hard mass; Consumption of gas will hurt yin in the future; In the late stage of yin-qi failure, the treatment should be mainly to soften the liver and nourish the kidney. (1) Symptoms: depression, chest tightness, hypochondriac pain, dysphagia, loss of appetite, abdominal distension or nausea after meals, emaciation and fatigue, loose stool with prominent eyes, large thyroid gland, pale and fat tongue, teeth marks, thin, white and greasy fur, and smooth pulse. Treatment: invigorating the spleen to relieve depression, eliminating dampness and phlegm, softening hardness and eliminating furuncle. Prescription: Xiaoyao Powder and Liujunzi Decoction: Bupleurum, Angelica, Atractylodis Rhizoma, Poria, Glycyrrhiza, Rhizoma Pinelliae Preparata, Pericarpium Citri Tangerinae, Rhizoma Cyperi, Radix Paeoniae Alba, Tribulus terrestris, Prunella vulgaris, Semen Sinapis Albae and Euphorbia helioscopia. (2) Deficiency of both qi and yin: Syndrome: emaciation, mental fatigue, fear of heat and sweat, palpitation, weakness of waist and knees, goiter; The tongue is red, the fur is thin and yellow, and the pulse is thin. Treatment: It is advisable to replenish qi and nourish yin. Prescription: Shengmai Decoction and Liuwei Dihuang Decoction: Radix Codonopsis, Radix Ophiopogonis, Fructus Schisandrae Chinensis, Radix Rehmanniae, Rhizoma Dioscoreae, Corni Fructus, Radix Paeoniae Alba, Radix Astragali, Fructus Lycii, Concha Ostreae, Radix Polygoni Multiflori Preparata, Radix Glycyrrhizae, etc. (3) Yang hyperactivity due to yin deficiency: Syndrome: upset and insomnia, palpitation, backache and fatigue, fear of excessive sweating due to heat, red face and excessive internal heat, impatience and irritability, trembling fingers, overeating, thirst and emaciation, red or reddish tongue, and thin and thin pulse. Treatment: benefiting qi and nourishing yin, nourishing kidney and subduing yang. Prescription: Radix Astragali, Radix Codonopsis, Radix Rehmanniae, Fructus Lycii, Radix Polygoni Multiflori Preparata, Rhizoma Dioscoreae, Carapax et Plastrum Testudinis, Radix Paeoniae Alba, Carapax Trionycis, Prunella vulgaris, Rhizoma Cyperi, etc. White mustard seed is added to those with obvious goiter; Palpitation and insomnia Jia Yuanzhi, a spiritual magnet; Tremor of hands and mother-of-pearl and Uncaria rhynchophylla; Gypsum Fibrosum and Rhizoma Anemarrhenae are added for patients with severe stomach heat and easy hunger; Trichosanthes root, Ophiopogon japonicus, Scrophularia etc. The specific prescription is 1. Single prescription 1 time a day. 2. Symptomatic treatment of traditional Chinese medicine: Traditional Chinese medicine is also commonly used for symptomatic treatment of hyperthyroidism. For example, hyperhidrosis in patients with hyperthyroidism can be treated with oyster powder, or with large doses of astragalus and floating wheat. On the basis of general treatment, Semen Ziziphi Spinosae, Radix Polygalae, Os Draconis, Caulis Polygoni Multiflori and Mother of Pearl can be used for common anxiety symptoms of hyperthyroidism, such as palpitation, insomnia and dreaminess. 3. A large number of clinical data prove that most hyperthyroidism patients have symptoms of deficiency of both qi and yin, and of course other syndromes can be combined on this basis. Shanghai University of Traditional Chinese Medicine focuses on reusing Radix Astragali, and has formed a "hyperthyroidism prescription": Radix Astragali, Prunellae Spica, Radix Paeoniae Alba, Polygonum Multiflori Radix and Radix Rehmanniae. The dosage of Astragalus membranaceus in the prescription is 45g. They compared the curative effects of Kangjiachong recipe and the prescription composed of several drugs left after removing Astragalus membranaceus on hyperthyroidism patients, and both of them had obvious curative effects on improving the symptoms of hyperthyroidism patients, among which Kangjiachong recipe decreased the "hyperthyroidism index integral" of patients more obviously. After the treatment of Kangjia Granule, the serum T3 and T4 of the patients decreased obviously, which also had a certain regulatory effect on the cellular immune function of the patients. However, the treatment of nourishing yin without adding astragalus can only improve the symptoms of patients, but can not reduce the levels of T3 and T4 and regulate immune function. Using a large dose of Astragalus membranaceus not only has a high cure rate, but also has a low recurrence rate, which can play a fundamental role. This synergistic effect of invigorating qi and nourishing yin in the treatment of hyperthyroidism is the best annotation to the theory of "Yang gives birth to yin" and "Yin helps Yang and springs are inexhaustible" in traditional Chinese medicine. Chinese patent medicine treatment 1. Liuwei Dihuang Pill: Bushen Yin. Take 1 pill twice a day. It is suitable for patients with liver and kidney yin deficiency syndrome. 2. Tianwang Buxin Dan: Buxin Yin, nourishing blood and calming the nerves. Take 1 pill twice a day. It is suitable for patients with yin deficiency of heart and liver. Examples of recipes for hyperthyroidism are shown in the table below. Therapeutic diet reference cookbookNo. 1 glutinous rice 50g steamed bread 140g eggs 50g dried bean curd 50g soybean oil 10g salt 2g second milk 20g sugar 20g third japonica rice 150g lean pork 50g hairtail 100g water bamboo 85g green pepper 80g soybean oil/kloc-0. Second-class lotus root starch 30g sugar 20g cake 50g No.5 japonica rice 150g lean beef 80g duck 50g tofu 100g lettuce 10g soybean oil10g salt 3g 6 banana 180g total heat energy 13.78MJ(3296.2kcal Nitrogen: heat energy 1: 150.32 P/S ratio 1.30 carbohydrate 509.8g(6 1.8%) protein 137.0g( 16.6%). Bean protein 17.8g( 13.0%) cholesterol 667. 1mg dietary fiber 9.87g iodine 27.5μg potassium 3005.8mg calcium 902.7mg phosphorus 1835.4mg sodium 2532.5mg vitamin C/kloc-0. Lunch: rice (rice 100g), braised beef (beef 150g), stewed tofu with Chinese cabbage (Chinese cabbage 100g, tofu 100g). Meal: red lotus root starch (50 grams of lotus root starch) and 50 grams of cake. Dinner: steamed stuffed bun 100g (flour 100g, lean pork 50g, Chinese cabbage 20g), moo Shu pork 100g (lean pork 30g, yellow flower 10g, fungus 5g), tomato and egg soup (tomato 50g, egg 50g). Dinner in the evening: milk (250g fresh milk, 10g sugar). 40 grams of cooking oil for a whole day. The above recipes contain 3059 kilocalories (12780 kilojoules). Example 2 breakfast: 50g glutinous rice steamed bread140g eggs 50g dried bean curd 50g diet: 250g milk and 20g sugar lunch:150g lean pork 50g glutinous rice hairtail100g water bamboo 85g green pepper 80g diet: 30g lotus root starch and 20g sugar cake 50g dinner: Kloc-0/.5%) Animal protein 70.2 g (5 1.2%) Bean protein 17.8 g (13.0%) Cholesterol 67.1mg Dietary fiber 9.87g Iodine 27.5pg Calcium 902. Boil bergamot and seaweed with appropriate amount of water to remove residues, then add japonica rice and brown sugar to cook porridge. Daily 1 dose, taken continuously for 10 to 15 days, can regulate mental depression and emotional changes, and can soothe the liver and clear heat. (2) kelp seaweed drink: kelp, seaweed and oyster are decocted in water. 1 Once a day for several days, it can soothe the liver, clear heat, regulate qi and relieve depression. (3) Green persimmon cake: green persimmon1000g, and proper amount of honey. Remove pedicels from green persimmons, clean them, mash them and wring them into juice, put them in a pot and concentrate them until thick, then add 1 times honey, continue to fry them until thick, then turn off the fire and cool them, and assemble them for later use. Twice a day, each time 1 tablespoon, with boiled water 10 days to 15 days. It is mainly used for clearing away heat and purging fire, and is used for people who are uneasy, irritable and irritable, and have a hot face. (4) Bulbus Fritillariae Cirrhosae seaweed porridge: Bulbus Fritillariae Cirrhosae, Herba Zosterae Marinae and Radix Salviae Miltiorrhizae each 15g, Coicis Semen 30g, wax gourd 60g and appropriate amount of brown sugar. Bulbus Fritillariae Cirrhosae and Radix Salviae Miltiorrhizae decoct soup first, then remove dregs and cook porridge with other flavors. Bring warm clothes on an empty stomach every morning 15 ~ 20 days. Can be used for treating cervical swelling, nausea, loose stool and other diseases. (5) Stir-fry Dictyophora indusiata and Dictyophora edulis: Dictyophora indusiata and Dictyophora edulis 15g, oyster 30g, and appropriate amount of brown sugar. Decoct the juice with water and remove the residue. Daily 1 dose for 7 days to 10 days. Has effect in resolving phlegm, promote diuresis, softening and resolving hard mass. (6) Assorted tofu: 4 pieces of tofu, tomato150g, auricularia auricula15g, winter bamboo shoots15g, peas15g, wet starch 9g, raw oil 9g, and appropriate amount of seasonings such as onion, ginger and salt. Dietary attention to human iodine mainly comes from food, salt and water, and the daily intake is about 300 ~ 500 micrograms. Iodine is the raw material of thyroid hormone synthesis, and iodine deficiency will lead to insufficient thyroid hormone synthesis. In hypothyroidism, the feedback inhibition of thyroid stimulating hormone (TSH) is weakened, and TSH secretion is increased, leading to thyroid hyperplasia and hypertrophy. Fetal hypothyroidism will directly affect brain development. In iodine-deficient areas, iodine deficiency exists in both patients with goiter and residents without goiter. Goiter is only a manifestation of iodine deficiency compensation. On the contrary, long-term consumption of iodide or iodine-containing organic matter can also cause goiter caused by iodide. In short, both iodine deficiency and iodine excess can cause goiter. Temporary hypothyroidism is caused by the influence of goiter-producing substances on thyroid hormone synthesis. When the substance that produces goiter stops, thyroid function can recover on its own. In addition, in the case of malnutrition in protein, thyroid function tends to be low. Supplying enough protein and heat can improve thyroid function. In hypothyroidism, the plasma cholesterol content is not fast, but the excretion is slow, so the blood drug concentration, triglyceride and lipoprotein increase, which is more obvious in primary hypothyroidism. The degree of blood lipid increase is positively correlated with serum TSH level, so it is appropriate to limit fat intake. Thyroxine deficiency can affect the synthesis of erythropoietin, leading to the decline of hematopoietic function of bone marrow, and it is also related to menorrhagia, iron absorption disorder, gastric acid factor, vitamin B 12 and folic acid deficiency. For the above reasons. The diet of hypothyroidism patients must pay attention to the following points: (1) supplement appropriate amount of iodine and avoid using goiter-producing substances. 1) Supplementary iodized salt: In China, potassium iodide with the concentration of 1g is generally used to prevent and treat goiter, which significantly reduces the incidence rate and is suitable for endemic goiter areas. In addition, pregnant women should pay more attention to the supplement of iodized salt to prevent future generations from suffering from cretinism due to iodine deficiency of their mothers. 2) Avoid using goiter substances: Avoid eating Chinese cabbage, cabbage, rape, cassava, walnuts, etc. To avoid goiter. (2) Sufficient protein: Only when the mass of protein per person per day exceeds 20G, can the human protein balance egg be maintained. Amino acids are the basic components of protein, and about 3% of protein is constantly updated every day. During hypothyroidism, the renewal rate of intestinal mucosa slows down, the secretion glands of digestive juice are affected, the enzyme activity decreases, and the general albumin decreases. Therefore, it is necessary to supplement essential amino acids and protein to improve the condition. (3) Restricting fat and high cholesterol diet: Patients with hypothyroidism are often accompanied by hyperlipidemia, which is more obvious in primary hypothyroidism, so fat diet should be restricted. The daily fat supply accounts for about 20% of the total calories, and the diet rich in cholesterol is restricted. (4) correct anemia and supplement rich vitamins: anemia patients should supplement iron-rich diet, vitamin B 12, such as animal liver and folic acid, and supplement liver preparations when necessary. (5) Dietary distribution: 1) Suitable food: For hypothyroidism caused by iodine deficiency, appropriate amount of kelp and laver should be selected, and iodine can be supplemented with iodized salt, iodine soy sauce, iodine eggs and bread. When cooking, it should be noted that iodized salt wood should be put into boiling oil to avoid iodine volatilization and reduce iodine concentration. Protein can choose eggs, milk, all kinds of meat and fish; Plant proteins can complement each other, such as various bean products and soybeans. Supplying animal liver can correct anemia and ensure the supply of various vegetables and fresh fruits. 2) Avoid eating: avoid all kinds of raw goiter substances, such as Chinese cabbage, cabbage, rape, cassava, walnuts and so on. Avoid foods rich in cholesterol, such as cream, animal brains and internal organs. Limit the use of high-fat foods, such as cooking oil, peanuts, walnuts, almonds, sesame paste, ham, pork belly and sweet cheese. What should the diet of hyperthyroidism patients pay attention to? Hypersecretion of thyroid hormone in hyperthyroidism promotes metabolism of sugar, fat and protein, and accelerates oxidation. The body's heat production and heat dissipation are obviously increased, and the basal metabolic rate is abnormally increased. It is necessary to increase energy every day to correct the energy consumption in the body. Based on the above reasons, the diet of hyperthyroidism patients must pay attention to high calorie, high protein, high vitamins and supplement calcium, phosphorus, potassium, zinc and magnesium to correct the consumption caused by high metabolism and improve the systemic symptoms. (1) Three highs, one bogey and one moderate amount: refers to a diet with high calorie, high protein and high vitamins, a diet without iodine, and appropriate supplementation of calcium and phosphorus. Increase calorie supply: 1) Adequate carbohydrates should be given every day to correct excessive intake. The daily energy supply is 12540 ~ 14630 kilojoules (3 000 ~ 3 500 kilocalories), which is 50% ~ 75% higher than that of normal people to meet the increase of metabolic rate caused by excessive thyroxine secretion. 2) Ensure the supply of protein: provide 1.5g protein per kilogram of body weight every day, but limit animal protein. 3) Pay attention to vitamin supply: directly supply rich multivitamins. Because of the high energy consumption, it consumes a lot of enzymes and lacks a lot of water-soluble vitamins, especially B vitamins. Vitamin D is the main vitamin to ensure the intestinal absorption of calcium and phosphorus, so it should be supplemented, and vitamin A and vitamin C should be supplemented at the same time. 4) Appropriate supply of calcium and phosphorus: In order to prevent osteoporosis and pathological fractures, the supply of calcium and phosphorus should be appropriately increased, especially for patients and the elderly who can't control their symptoms for a long time. 5) Avoid foods and drugs containing iodine: iodine is the raw material for synthesizing thyroid hormone. There is a large amount of iodine in the thyroid gland, which accelerates the synthesis of thyroid hormone. Therefore, iodine can induce hyperthyroidism and aggravate its symptoms. Therefore, foods and drugs containing iodine should be avoided. All kinds of iodine-containing contrast agents should also be used with caution. (2) Increase the number of meals: In order to correct internal friction, in addition to the staple food of three meals a day, snacks are added between meals to improve the metabolic disorder of the body. (3) Dietary allocation: l) Direct election food: According to patients' usual eating habits, various starchy foods can be selected, such as rice, noodles, steamed bread, vermicelli, potatoes, pumpkins, etc. All kinds of animal foods, such as beef, pork, mutton, all kinds of fish, etc. All kinds of fresh fruits and foods rich in calcium and phosphorus, such as milk, nuts, fresh fish, etc. When potassium is low, you can choose oranges, apples and so on. 2) Avoid choosing foods: Avoid using foods containing iodine, such as kelp, laver, Nostoc flagelliforme and iodized salt. Traditional Chinese medicines such as arborvitae, kelp, seaweed, Prunella vulgaris, Salvia miltiorrhiza, Scrophularia, Cyperus rotundus and Fritillaria thunbergii are also taboo. 3) Pay attention to the sexual function of food: From the perspective of Chinese medicine, directly selecting food has the function of nourishing yin, such as soft-shelled turtle, soft-shelled turtle and duck. Eat less warm, spicy and irritating food, such as roosters.