A systematic review, meta-analysis, and trial sequential analysis of the effect of acupuncture and moxibustion cake on thyroid function in patients with Hashimoto thyroiditis.

BACKGROUND

Hashimoto thyroiditis (HT) is a prevalent autoimmune thyroid disorder that currently lacks a specific treatment. While oral levothyroxine sodium tablets have been found to significantly enhance thyroid function, they do not contribute to a decrease in concentrations of thyroid-related antibodies. We aimed to design a systematic review, meta-analysis, and trial sequential analysis of the effect of acupuncture and moxibustion cake on thyroid function in patients with HT.

METHODS

We conducted an unrestricted search up until March 29, 2024, across 7 databases. These included 4 international databases, namely, PubMed, Web of Science, Scopus, and Cochrane Library, as well as 3 Chinese databases such as CNKI, VIP, and Wanfang. We used Review Manager, version 5.3, for meta-analysis and presented the data as mean difference (MD) and 95% confidence interval to evaluate the role of acupuncture or moxibustion on biomarker levels in HT.

RESULTS

A total of 306 records were identified through databases, and 15 articles were included in the meta-analysis. In the acupuncture group: thyroid peroxidase antibody (TPOAb): the pooled MD is -61.97 (P < .00001), thyroglobulin antibody (TGAb): the pooled MD is -44.78 (P = .001), thyroid-stimulating hormone (TSH): the pooled MD is -2.64 (P < .00001), free triiodothyronine: the pooled MD is 0.47 (P = .09), and free thyroxine: the pooled MD is 1.46 (P = .02). In the moxibustion group: TPOAb: the pooled MD is -11.44 (P = .0002), TGAb: the pooled MD is -8.63 (P = .004), TSH: the pooled MD is -1.00 (P = .27), free triiodothyronine: the pooled MD is 1.12 (P = .14), and free thyroxine: the pooled MD is 1.04 (P = .07).

CONCLUSION

The meta-analysis indicates that acupuncture and moxibustion may influence thyroid-related biomarkers (TPOAb, TGAb, and TSH) in patients with HT; however, the evidence is highly limited by methodological weaknesses, heterogeneity, and publication bias. These factors preclude reliable clinical recommendations at this stage. Further well-designed, large-scale randomized controlled trials are essential to determine whether these interventions have true clinical efficacy.