探讨甲状腺功能减退症的心身学方面:基于肌肉骨骼变化、心理压力源和低镁水平的WOMED身心相互作用模型

Roy Moncayo, Helga Moncayo
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引用次数: 19

摘要

甲状腺功能减退症患者可出现一系列所谓的残余症状,据说这些症状没有物理病理。然而,这些症状对这些患者的健康状况产生了负面影响。目前对这种情况没有任何解释。基于先前对甲状腺疾病患者的调查,我们进行了以肌肉骨骼特征为中心的临床检查,并对心理应激源进行了简单的评估(量表1-3)。实验室诊断的重点是血清镁。本报告包括166名女性的数据,包括58名甲状腺功能正常的对照组(6名男性)和108名甲状腺功能减退患者(8名男性)。我们的患者中最常见的主诉包括疲劳、易疲劳、注意力不集中、踝关节不稳定、步态不安全、踝关节让位、小腿肌肉痉挛、视觉障碍、易怒和眩晕感。除此之外,绝大多数患者(89.5%)表现为肌肉骨骼改变。主要发现是侧张力,这需要一个偏心的肌肉行动的影响下肢。侧张力总是伴随着患侧半骨盆的(向前)旋转。发现特发性活动脚趾与侧张力无关。患者的压力评分高于对照组。患者血清镁水平明显降低(0.87±0.1 mmol/l vs. 0.92±0.07 mmol/l, p = 0.041),且与侧张强度和应激评分呈负相关。镁水平低于0.9 mmol/l的患者每日给予3x1.4 mmol柠檬酸镁400 mg形式的元素镁。在出现压力得分为2或3的病例中,治疗中包括放松治疗程序。这种治疗被扩展到使用针灸的穴位上的三焚经络。在90%的病例中观察到治疗成功,即残余症状不再存在,患者报告幸福感得到改善。我们假设镁缺乏是由身体和心理压力源的存在促成的。这种情况有可能对依赖镁- atp的氧化磷酸化复合体V的功能产生负面影响。因此,妇女需要大量能量的生殖过程可能受到影响。在我们的治疗方案之后,所谓的心身症状的消失为这一医学领域带来了新的曙光,它强调了整体处理的重要性。对身心相互作用的理解是通过讨论热力学、知觉、健康生成和恢复力以及萨满教来解释的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exploring the aspect of psychosomatics in hypothyroidism: The WOMED model of body–mind interactions based on musculoskeletal changes, psychological stressors, and low levels of magnesium

Patients with hypothyroidism can present a series of so-called residual symptoms which are said to be without physical pathology. These symptoms, however, affect negatively the well-being state of these patients. Currently there are no explanations for this situation.

Based on previous investigations done with thyroid disease patients we have carried out a clinical examination which is centered on musculoskeletal features together with a simple evaluation of psychological stressors (scaled 1–3). Laboratory diagnosis was focused on serum magnesium. This report includes the data from 166 women including 58 euthyroid controls (six males) and 108 patients with hypothyroidism (eight males).

The most common complaints seen in our patients included fatigue, being easily tired, concentration deficit, ankle instability, and gait insecurity, giving way of the ankle, muscle cramps in the shanks, visual disturbances, irritability, and vertigo sensation. Besides this symptomatology a great majority of the patients (89.5%) presented musculoskeletal alterations. The main finding was that of lateral tension which entails an eccentric muscle action of the affected lower extremity. Lateral tension was always accompanied by (forward) rotation of the hemi-pelvis of the affected side. Idiopathic moving toes were found to be independent of lateral tension. Stress scores in patients were higher in patients than in the control group. Serum magnesium levels were significantly lower in patients (0.87 ± 0.1 mmol/l vs. 0.92 ± 0.07 mmol/l, p = 0.041) and showed a trend toward an inverse correlation to the intensity of lateral tension as well as to the stress score. Patients having magnesium levels below 0.9 mmol/l received 3× 1.4 mmol daily of elemental magnesium in the form of 400 mg of magnesium citrate. In cases presenting stress scores of 2 or 3 a relaxation treatment procedure was included in the treatment. This treatment was extended to the use of acupuncture on points of the Triple Burner meridian. Treatment success was observed in 90% of cases, i.e. residual symptoms were no longer present and patients reported an improved feeling of well-being.

We hypothesize that magnesium deficit is facilitated by the presence of physical and psychological stressors. This condition has the potential to negatively influence the function of Complex V of oxidative phosphorylation which relies on magnesium-ATP. Reproductive processes, which have high energetic requirements in women, could thus be affected. The disappearance of the so-called psychosomatic symptoms after our therapeutic scheme brings a new light into this field of medicine and it stresses the importance of holistic handling. Understanding of body–mind interactions is explained by discussing thermodynamics, noesis, Salutogenesis and Resilience, and shamanism.

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