From Tradition to Future: Pathophysiological Mechanisms and Clinical Research Progress in the Treatment of Hypothyroidism with Traditional Chinese Medicine——A Narrative Review

Lei Piao,1 Jian Ma,2 Na Zhao,2 Chunyan Liu,2 Yongqing Hou,1 Tehasi Wang1 1Department of Graduate School, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People’s Republic of China; 2Department of Endocrinology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, People’s Republic of ChinaCorrespondence: Jian Ma, Department of Endocrinology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, 26 Heping Road, Harbin, Heilongjiang, 150040, People’s Republic of China, Email [email protected]: Hypothyroidism, a prevalent endocrine disorder primarily resulting from inadequate thyroid hormone secretion, is commonly attributed to etiologies, such as Hashimoto’s thyroiditis and iodine deficiency. Currently, levothyroxine (LT4) replacement therapy is the standard treatment in Western medicine. However, suboptimal therapeutic responses in certain patients have motivated the investigation of alternative interventions. In recent years, TCM, particularly the integrative approach of combining acupuncture with herbal medicine, has demonstrated promising potential in the management of hypothyroidism. Through a systematic review of 12 randomized controlled trials (RCTs) onTCM for hypothyroidism conducted in the past decade, this article found that TCM exerts therapeutic effects by regulating immune function, improving thyroid antibody levels, and modulating metabolic status. Commonly used herbs include Astragalus membranaceus (Huangqi), Codonopsis pilosula (Dangshen), and Rehmannia glutinosa (Shudihuang), whose mechanisms of action involve key signaling pathways such as MAPK and PI3K-AKT.Acupuncture and moxibustion therapies target specific acupoints (e.g. Guanyuan and Zusanli) to improve thyroid function by regulating apoptosis and the associated signaling cascades. Multiple randomized controlled trials have demonstrated that the combination of acupuncture and herbal medicine not only significantly ameliorates clinical symptoms, but also modulates serum concentrations of TSH, T3, and T4, thereby enhancing treatment efficacy. Nonetheless, current research is limited by factors such as small sample sizes, insufficient long-term follow-up, and a lack of comprehensive mechanistic studies. Future investigations employing large-scale, multi-center, high-quality clinical trials are warranted to further substantiate the efficacy and safety of these integrative therapeutic modalities.Keywords: hypothyroidism, TSH, TCM, acupuncture and moxibustion