Thyroid UK

A systematic review of combinatorial treatment with warming & invigorating drugs and levothyroxine for hypothyroidism caused by Hashimoto's

Does anyone here understand the meaning of this paper? It reads as if it has some promise but I really struggle to make much sense of it.

Ann Transl Med. 2016 Dec;4(23):459. doi: 10.21037/atm.2016.12.16.

A systematic review of combinatorial treatment with warming and invigorating drugs and levothyroxine for hypothyroidism caused by Hashimoto disease.

Cheng X1, Wei Z2, Zhang G2, Shao X2, Li B3, Gao R2.

Author information

1Graduate School of China Academy of Chinese Medical Sciences, Beijing 100700, China;; Tianjin University of Traditional Chinese Medicine, Tianjin 300073, China.

2Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China.

3Beijing Hospital of Traditional Chinese Medicine, Affiliated with Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing 100010, China.



We used the systematic review method to evaluate the clinical efficacy and safety of combinatorial treatment with warming and invigorating drugs and levothyroxine on hypothyroidism caused by Hashimoto thyroiditis (HT).


We set inclusion and exclusion criteria, searched for studies using electronic databases and manual retrieval, selected studies according to the inclusion and exclusion criteria, and assessed the qualities of the included studies according to the Jadad scale. We performed a meta-analysis and analyzed the biases and sensitivities of the results using Revman 5.3 software.


We retrieved 94 and 7 of the studies met the inclusion criteria. Warming and invigorating drugs and levothyroxine increased free triiodothyronine (FT3) and free thyroxine (FT4) levels and reduced thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TGAb) levels more than levothyroxine alone. However, the FT4 data were not stable. There were no statistically significant differences between the experimental and the control groups with regards to the effects on traditional Chinese medicine (TCM) syndromes and total therapeutic effects. There was insufficient evidence to make conclusions regarding TCM syndromes scores, goiter reduction, recurrence rate, and adverse reactions.


Warming and invigorating drugs combined with levothyroxine may improve treatment of hypothyroidism caused by HT more than levothyroxine alone based on the FT3, FT4, TSH, TPOAb, and TGAb results. Based on the low qualities of the included studies, further evidence is needed to confirm these conclusions.


Hashimoto disease; hypothyroidism; traditional Chinese medicine (TCM); warming and invigorating drugs

PMID: 28090515

DOI: 10.21037/atm.2016.12.16

Follow the link above to the article including full text options (e.g. PDF download).

2 Replies

It's a meta analysis, they find every study on a subject and filter them by 'quality' criteria. They then do a statistical analysis of the few papers that pass their criteria and report the results. Dr Skinner didn't think much of this technique. As someone who studied mathematics I think it's rubbish, you can't assign weighting factors to selected factors. You have to study each paper and take a critical view.

This paper looked at Chinese medicine where herbs have warming or cooling properties. Herbs that produce warming effects seemed to assist levothyroxine a little. Wow!


My understanding is that the TCM concepts of 'warming' and 'cooling' are a bit abstract (they serve to balance yin and yang, 'tonify qi' etc) so without knowing what the herbs are I can't see how this makes much scientific sense. Not to say TCM has no active healing properties, I just don't know how you can quantify these properties without a lot more information.


You may also like...