Should hyperthyroidism patients consider combining Chinese and Western medicine?

May 4 2007

It might not be a bad idea for people with overactive thyroids to supplement their standard treatment with Chinese herbal medicine, a new review suggests.

But while some of the studies supported the combination of two types of medicine, the reviewers say the quality of the research was questionable.

“Unfortunately, we cannot find a well-designed and conducted trial at this stage,” said Taixiang Wu, an associate professor at Sichuan University in China.

Hyperthyroidism occurs when the thyroid gland produces too much thyroid hormone, causing problems that can mimic the effects of a shot of adrenalin, said Jeffrey Sandler, M.D., an endocrinologist with Scripps Mercy Hospital and Whittier Institute in San Diego. “It stimulates the heart rate, can raise blood pressure, breaks down muscle and can cause weakness and weight loss.”

Increased thyroid hormone can lead to higher body temperatures and warm, moist skin as well. The cause of hyperthyroidism is typically Graves' disease, where cells of the immune system work against the thyroid gland.

Hyperthyroidism is most common among women and the drugs used to treat it have been around for about 50 years, Sandler said. In extreme cases, doctors turn to surgery and radiation.

In this new Cochrane Library review, the researchers looked for studies that compared hyperthyroidism patients who took Chinese herbal medicine alone to those who took it in combination with Western treatments.

The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews like this one draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The reviewers were only able to find 13 relevant studies whose authors were available to interview. The researchers excluded 52 other studies whose authors they could not reach.

According to the reviewers, the 13 studies — with 1,770 people — were all of “low quality.” Types of herbal treatment varied widely, with 103 different formulations included.

None of the studies analyzed death rates, health-related quality of life or participants' willingness to follow the regimens. And none used a “double-blinding” approach, in which both researchers and subjects are initially prevented from knowing who's getting which treatment.

The studies indicated that combinations of Chinese herbal medicines and Western antithyroid drugs might lower relapse rates, reduce side effects and relieve symptoms of hyperthyroidism, but the Chinese treatments didn't seem to have much of an effect on the functioning of the thyroid itself.

While understanding of hyperthyroidism is a product of modern times, Chinese doctors have presumably been treating patients with the condition for some 2,000 years, said Subhuti Dharmananda, director of the Institute for Traditional Medicine in Portland, Ore. Chinese research focused on specific treatments, however, only goes back to the 1970s and 1980s, he said.

Should hyperthyroidism patients consider combining Chinese and Western medicine? “At this point, there is no wisdom available one way or the other,” Dharmananda said. “My recommendation to people is that if they are drawn to using Chinese medicine as part of their therapy, that they find a good practitioner in their area and undertake a program of treatment to see if it helps.”

He added, “It is possible that Chinese medicine can, for example, alleviate some of the symptoms of hyperthyroidism or help maintain good health after modern treatment for the disease.”

As for the current Western treatment, “we do pretty well with what's currently available and standard,” Sandler said.

Regarding alternative treatments, “the problem is that when you're dealing with a disease where it's important to have the right dosage of medication,” Sandler said. Indeed, the proper dose of one thyroid medication can range from 50 to 1,200 milligrams depending on the person, he said

“Things like herbal medicines and supplements are not reliably predictable, and the doses may vary from batch to batch or manufacturer to manufacturer,” Sandler said. “You're dealing with a situation where there isn't a great deal of control.”

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.