Thyroid disease includes hypothyroidism, a clinical consequence of deficient secretion by the thyroid gland, and hyperthyroidism, where overproduction of thyroid hormone leads to a state of thyrotoxicosis, (Weetman 2003).
Overt hypothyroidism is diagnosed by a serum thyroid-stimulating hormone (TSH) concentration above the normal reference range and a serum free thyroxine (FT4) concentration below the reference range (BTA 2006). Clinical features may be absent or present. Subclinical hypothyroidism is diagnosed by a TSH concentration above the reference range with an FT4 concentration within the reference range (BTA 2006). Clinical features are usually absent.
In the UK, hypothyroidism is usually due to autoimmune hypothyroidism or thyroid damage after surgery or radioactive iodine therapy.(Wheetman 2003). It may be associated with a goitre (Hashimoto’s thyroiditis) or without (atrophic thyroiditis or primary myxoedema). The prevalence of overt hypothyroidism is 1.9% in women and 0.1% in men (Tunbridge 977), and of subclinical hypothyroidism is about 8% in women and 3% in men in the UK.(Vanderpump 1995).
The most common symptoms are tiredness, weight gain, constipation, aches, dry skin, lifeless hair and feeling cold. Hypothyroidism is treated with levothyroxine.
Overt hyperthyroidism is diagnosed when TSH is suppressed and FT4 or free tri-iodothyronine (FT3) levels are higher than the normal reference range (Nygaard 2007). Subclinical hyperthyroidism is diagnosed when TSH is suppressed but FT4 and FT3 levels are within the normal reference range. Clinical symptoms and signs are typically absent, mild, or non-specific in people with subclinical hyperthyroidism. (BTA 2006) The prevalence of hyperthyroidism is about 2%, and it is about 10 times as common in women as men (Tunbridge1977; Vanderpump 1995). The prevalence of subclinical hyperthyroidism is less than 2% in adults (AACE Thyroid Task Force 2002). Thyroid eye disease affects about 400,000 people in the UK (0.66%) (Cawood 2004).
Primary hyperthyroidism is due to excessive production of thyroid hormone caused by thyroid overactivity. The most common cause is Graves’ disease, an autoimmune disorder. Ophthalmopathy occurs in 25–50% of people with Graves’ disease (Cooper 2004; Reid and Wheeler 2005)
Symptoms of thyrotoxicosis include breathlessness, palpitations, hyperactivity, emotional lability, insomnia, irritability, nervousness, anxiety, exercise intolerance, fatigue, muscle weakness, diarrhoea, increased sweating, increased appetite with weight loss or gain, infertility, polyuria, thirst, generalised itch, and reduced libido and gynaecomastia in men. Complications include Graves’ ophthalmopathy; thyrotoxic crisis; atrial fibrillation; congestive cardiac failure; and increased risk of miscarriage, eclampsia, premature labour, low birthweight and neonatal thyrotoxicosis, when it is untreated during pregnancy (Cooper 2003; Weetman 2003). Hyperthyroidism is treated with drugs (carbimazole, propylthiouracil, beta-blockers), radioiodine and surgery.
AACE Thyroid Task Force. AACE medical guidelines for the evaluation and treatment of hyperthyroidism and hypothyroidism. American Association of Clinical Endocrinologists 2002. Available: www.aace.com
BTA, ACB and BTF. UK guidelines for the use of thyroid function tests. Association for Clinical Biochemistry, British Thyroid Association, British Thyroid Foundation 2006. Available: www.acb.org.uk
Cawood T et al. Recent developments in thyroid eye disease. British Medical Journal 2004; 329: 385-90.
Cooper DS. Hyperthyroidism. Lancet 2003: 362(9382; 459-68.
Cooper DS. Subclinical thyroid disease: consensus or conundrum? Clinical Endocrinology 2004; 60: 410-2.
Nygaard, B. Hyperthyroidism. Clinical Evidence 2007. BMJ Publishing Group Limited. Available: www.clinicalevidence.com
Reid JR, Wheeler SF. Hyperthyroidism: diagnosis and treatment. American Family Physician 2005; 72: 623-30.
Tunbridge WMG et al. The spectrum of thyroid disease in a community: the Whickham survey. Clinical Endocrinology 1977; 7: 481-93.
Vanderpump MPJ et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clinical Endocrinology 1995; 43: 55-68.
Weetman, AP. The thyroid gland and disorders of thyroid function. In: Warrell, D.A., Cox, T.M., Firth, J.D. and Benz, E.J.Jr (Eds.) Oxford textbook of medicine. 4th edn. Oxford: Oxford University Press 2003. Section 12.4
How acupuncture can help
This factsheet focuses on the evidence for acupuncture in thyroid disease, both hypothyroidism and hyperthyroidism.
One randomised controlled trial (RCT) found that the use of moxibustion separated from the skin by a layer of aconite herbal ‘cake’, in addition to levothyroxine, can improve clinical symptoms and thyroid function in patients of Hashimoto’s thyroiditis compared with levothyroxine alone (Xia 2012). An observational study found that acupuncture may be an alternative to treatment with levothyroxine for subclinical hypothyroidism (Luzina 2011).
Three RCTs have looked at acupuncture for hyperthyroidism. One found that acupuncture combined with acupressure is effective for treating infiltrative exophthalmos (bulging eyes, a common symptom in thyroid eye disease), and more effective than medication (Xu 2011). Another found that the addition of acupuncture to medication for hyperthyroid exophthalmos may not only enhance the therapeutic effects of medication, but also reduce the side effects. (Xia 2010) And, a third found that pricking therapy has a definite therapeutic effect on Graves’ disease, via regulation of thyroid function (Li 2006).
In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being.
Research has shown that acupuncture treatment may specifically help in thyroid disease by:
- Increasing free thyroxine (FT4) and free tri-iodothyronine (FT3) levels in hypothyroidism (Xia 2012; Hao 2009; Hu 1993);
- Decreasing serum tri-iodothyronine (TT3), total thyroxine (TT4), free T3 (FT3) and free T4 (FT4) levels and increasing supersensitive thyrotropin (S-TSH) levels in hyperthyroidism (Li 2006);
- Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);
- Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);
- Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling;
- Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007);