Hypothyroidism
The treatment of hypothyroidism is infrequently mentioned in Chinese literature and is not a common subject of clinical studies. This may result from a less frequent diagnosis of the disorder, since the fatigue, water retention, and chills characteristic of hypothyroidism are standard symptoms belonging to traditional categories such as qi and yang deficiency. These conditions usually do not present immediate need for Western medical attention as might occur with the irregular heart rate of hyperthyroidism. The relatively infrequent reporting may also result from a lower incidence of the disease in China.
Patients with Hashimoto’s thyroiditis have reduced responsiveness to TSH. The disease can spontaneously remit, and this change can be detected, even while thyroxine replacement therapy continues, by testing for TSH responsiveness. In one evaluation, about 24% of patients were seen to experience spontaneous remission, though no remissions were found among patients with diffuse goiter.29
The basic herbal treatment for hypothyroidism is to administer qi and yang tonics. For example, 19 cases of hypothyroidism of various causes (10 due to thyroid operation or irradiation in the treatment of hyperthyroidism, three were chronic lymphatic thyroiditis, 6 due to unknown causes) were treated for 2 to 4 months with a thyroid tablet containing codonopsis and astragalus to tonify qi, and epimedium, curculigo, and cuscuta to tonify yang (with cooked rehmannia to balance the yin and yang).32 The patients received either herbs alone or herbs with thyroxine. A control group received thyroxine alone. The Chinese herbs improved clinical symptoms, reduced cholesterol and thyroid-stimulating hormone levels, and increased T3 and T4. The addition of thyroxine (at 60 mg per day) gave even better results. A similar prescription, adding psoralea in the standard formula, and aconite and cinnamon twig for more severe cases, was given to seven patients with hypothyroidism, and it was claimed that all patients showed improvement with 2 to 3 months of treatment.14. Five of the patients took a small dosage of thyroxine.
In a study of 22 patients with hypothyroidism, 19 of the cases were caused by thyroid treatments (radioactive iodine, surgery, antithyroid drugs).22 A decoction of aconite, cinnamon bark, ginseng, astragalus, lycium fruit, epimedium, deer antler, psoralea, morinda, salvia, atractylodes, and hoelen was given. Thyroxine tablets were also provided as needed during the treatment period. After 2 months of therapy, of the 22 patients, 17 had their clinical symptoms eliminated, and the T3, T4, and TSH returned to normal levels, while the other five patients showed partial improvement in both symptoms and laboratory values. In one patient cured by this treatment, a follow-up visit after five years showed that she remained healthy.
Five patients with lymphatic thyroiditis were treated with a combination of astragalus and codonopsis (30 grams each) to tonify qi, aconite, cinnamon bark, curculigo, and epimedium (9 to 12 grams each) to tonify yang, and lycium fruit plus coix.50 The decoction of herbs, modified as necessary to treat symptoms such as indigestion with diarrhea or constipation, was taken in two divided doses daily for two to three months. The mean body weight of the patients declined from 63 kg to 60 kg, the heart rate increased from 66 to 75 per minute, and cholesterol dropped from 260 to 202. T3 and T4 values increased markedly, while TSH declined.
Six patients treated with a high dose decoction of licorice (10 grams) and ginseng (8 grams, reduced to 6 grams after the first month) for three months, using thyroxine in reducing amounts from the beginning to the end of the treatment program, showed good results.28 Four patients had basal metabolic rate, T3, and T4 return to normal or near normal values and improved symptoms which persisted after the treatment ended; two others improved while on the herbs but within one year of stopping the therapy the symptoms returned and could be controlled by using the decoction again.
As reported in Recent Advances in Chinese Herbal Drugs, an evaluation of patients with kidney yang deficiency syndrome who were not classified as suffering from hypothyroidism but were rather suffering from chronic bronchitis revealed a decreased level of T3 and T4 (average values of 102 and 8.2 respectively). Both chronic bronchitis patients not having kidney yang deficiency and normal adults had comparable levels of these hormones (147 and 9.3 respectively). When the kidney yang deficiency patients were treated for five months using a kidney tonic prescription (ingredients not specified), T3 levels increased (average 164; slightly higher than normal). Thus, kidney yang deficiency may be directly associated with hypothalamus-pituitary-thyroid function which is affected by corrective herbal therapies.
In contrast to the hyperthyroid treatments, herbs for dispersing phlegm and resolving masses are generally not included for hypothyroid cases, and instead the focus is on tonification therapy.
A somewhat different approach has been used in two studies, in which tonics are still an important aspect of the treatment but qi and blood regulating herbs are also used. This method was applied in the treatment of 133 patients with Hashimoto’s thyroiditis.34 A combination of cyperus, saussurea, cnidium, curcuma, and bupleurum was modified by adding one of two tonic prescriptions: polygonatum, dioscorea, moutan, hoelen, and lycium for qi and blood deficiency patients and Rehmannia Eight Formula for yang deficiency patients. By taking the powdered herbs in pill form for 1 to 5 months, 29% were cured.
In another study, 38 patients with Hashimoto’s thyroiditis were treated with codonopsis (or ginseng), plus pinellia, hoelen, and licorice to tonify qi and normalize the digestion, and citrus, blue citrus, salvia, and red peony to regulate qi and blood.51 Patients still showing hyperthyroid symptoms were additionally given the yin nourishing combination of asparagus, ophiopogon, rehmannia, and schizandra, while those showing hypothyroid symptoms were given the yang tonifying combination of cinnamon twig, deer antler, and epimedium. In the event that a thyroid nodules existed (four cases), sparganium and zedoaria would be given. A control group with 20 patients were treated with standard thyroid drugs. Treatment time was 6 months. Among the group treated with Chinese herbs, 55% of those with hyperthyroid conditions and 93% of those with hypothyroid conditions had normal thyroid levels following treatment. There was no significant difference between this outcome and the results of using Western medicine in the control group.
It is not evident from these two studies that the addition of qi and blood regulating herbs enhanced the outcome of treatment compared to relying primarily on qi and yang tonic herbs alone. Among the several studies of hypothyroid treatment, it does appear that longer treatment times produce better effects.
Long-Term Follow-up
A one year follow-up to a study of Jiakangling administered for 3 months, either alone or with Western medication (thiamazole or propranolol), revealed that 85.2% of those treated with herbs only and 90% of those treated with herbs and drugs maintained the improvements that had been attained during the treatment period.5 In a study of senile hyperthyroidism, a typical case was presented in which 30 days of decoction was consumed and a follow-up visit one year later showed no recurrence.19 In 45 cases of hyperthyroidism said to be cured by an astragalus-based formula (Yiqiyangyin Tang), recurrence was noted in only two cases.21 Follow-up duration was from less than 6 months to 4 years (12 cases under 6 months and 33 cases from 6 months to 4 years).
In the study of herb treatments for hyperthyroidism, in which exophthalmos was a symptom, a follow-up 4 years later showed no recurrence of the initial condition.12 Forty cases of hyperthyroidism treated with herbs for an average of 67 days yielded 24 cures and the remaining 16 either markedly improved or somewhat improved. One year later, the therapeutic benefits remained stable.35
Individual cases mentioned in the reports describing various treatments for hyperthyroid or hypothyroid conditions suggested that 1- to 5-year follow-up demonstrated continued relief, but that a few individuals might experience a relapse that could be treated effectively by applying again the original treatment. From those studies involving longer-term treatment at the outset, it was evident that symptom improvement might be attained early, but continued administration of herbs was essential to further improve or maintain that effect.
