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Acupuncture Shows Significant Antibody Reductions in Hashimoto Thyroiditis, but Evidence Remains Weak
A systematic review and meta-analysis of 15 trials found that acupuncture was associated with substantially lower thyroid peroxidase antibody levels in patients with Hashimoto thyroiditis (pooled mean difference –61.97, P < .00001), alongside meaningful reductions in thyroglobulin antibody and TSH; moxibustion also produced statistically significant antibody reductions, though smaller in magnitude. These findings carry low confidence owing to marked methodological limitations across the included studies.
What Was Studied
This review investigated whether acupuncture and moxibustion cake — two traditional interventions — could meaningfully alter thyroid autoimmune biomarkers, specifically thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TGAb), and thyroid-stimulating hormone (TSH), in patients diagnosed with Hashimoto thyroiditis, a common autoimmune thyroid disorder for which no targeted therapy currently exists.
How It Was Studied
Researchers conducted a systematic review and meta-analysis with an unrestricted search across seven databases — four international (PubMed, Web of Science, Scopus, and Cochrane Library) and three Chinese (CNKI, VIP, and Wanfang) — with records retrieved up to March 29, 2024. From 306 identified records, 15 articles met inclusion criteria and contributed data to pooled analyses. The patient population consisted of individuals with confirmed Hashimoto thyroiditis, and the clinical context placed oral levothyroxine sodium as the standard treatment backdrop against which acupuncture and moxibustion were evaluated. Pooled estimates were expressed as mean differences (MD) with 95% confidence intervals, calculated using Review Manager version 5.3.
What Was Observed
- Acupuncture and TPOAb: Acupuncture was associated with a large reduction in thyroid peroxidase antibody levels compared with control conditions, with a pooled mean difference of –61.97 (P < .00001). This is the largest effect observed across all outcomes and interventions in the review, though the clinical magnitude must be interpreted cautiously given evidence quality concerns.
- Acupuncture and TGAb/TSH: Acupuncture also produced statistically significant reductions in thyroglobulin antibody (pooled MD –44.78, P = .001) and thyroid-stimulating hormone (pooled MD –2.64, P < .00001). Reductions in free thyroxine approached significance (MD 1.46, P = .02), while free triiodothyronine did not reach significance (MD 0.47, P = .09).
- Moxibustion and antibody levels: Moxibustion was associated with statistically significant, though numerically smaller, reductions in both TPOAb (pooled MD –11.44, P = .0002) and TGAb (pooled MD –8.63, P = .004), suggesting a measurable effect on autoimmune markers even with this distinct intervention modality.
- Moxibustion and thyroid hormone parameters: In contrast to antibody outcomes, moxibustion did not produce statistically significant changes in TSH (MD –1.00, P = .27), free triiodothyronine (MD 1.12, P = .14), or free thyroxine (MD 1.04, P = .07), indicating that its effects may be more narrowly concentrated on antibody profiles.
Why This Matters
Hashimoto thyroiditis currently lacks a specific pharmacological treatment, and while levothyroxine can support thyroid hormone levels, it does not reduce the thyroid-related autoantibodies that characterize the condition. The finding that both acupuncture and moxibustion may modulate TPOAb and TGAb offers preliminary pooled evidence for biological activity in a domain where standard therapy has little impact. This positions these interventions as candidates for further rigorous investigation, specifically through large-scale randomized controlled trials designed to address the methodological gaps identified in the current evidence base.
How to Read This Result
Although the direction of findings is consistently positive for both acupuncture and moxibustion across key autoimmune biomarkers, overall evidence quality is low due to high heterogeneity among studies, methodological weaknesses in the primary trials, and the presence of publication bias, all of which substantially undermine confidence in the pooled estimates.
Limitations
The authors explicitly caution that the evidence base is highly limited by methodological weaknesses in included trials, substantial heterogeneity across study populations and protocols, and detectable publication bias. These factors collectively prevent the derivation of reliable clinical recommendations, and the authors emphasize that well-designed, large-scale randomized controlled trials are necessary before any conclusions about clinical efficacy can be drawn.