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Achievements in Hypothyroidism Treatment with Herbal Medicine: A Systematic Review of Randomized Controlled Trials.

  • 2023-09
  • Current drug discovery technologies 20(5)
    • Najmeh Javidi
    • Zahra Mazloum Khorasani
    • Roshanak Salari
    • Shabnam Niroumand
    • Mahdi Yousefi

Study Design

Type
Systematic Review
Sample size
n = 186
Population
186 participants with primary hypothyroidism from 4 trials
Methods
Systematic review of PubMed, Embase, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials until May 4, 2021; selected randomized clinical trials (RCTs) assessing herbal medicine effects.

Background

Hypothyroidism is a common endocrine disease in the world that causes morbidity and mortality due to its association with metabolic diseases, especially in old age, and longterm treatment with levothyroxine causes many side effects for patients. Treatment with herbal medicine can regulate thyroid hormones and prevent side effects.

Objective

The purpose of this systematic review is the evaluation of the effect of herbal medicine on the signs and symptoms of primary hypothyroidism.

Methods

PubMed, Embase, Google Scholar, Scopus, and Cochrane Central Register of Controlled Trials were searched until 4 May, 2021. We selected randomized clinical trials (RCTs) that have assessed the effect of herbal medicine on hypothyroidism.

Results

Out of 771 articles, 4 trials with 186 participants were included. In one study, Nigella sativa L. caused a significant decrease in weight (P=0.004) and body mass index (BMI) (P=0.002). TSH levels were reported to be decreased and T3 increased in the treatment group (P =0.03) (P=0.008), respectively. In another study on Nigella sativa L., results did not show a significant difference between the two groups (p=0.02). A significant decrease in total cholesterol (CHL) and fasting blood sugar (FBS) was reported in participants with negative anti-thyroid peroxidase (anti-TPO) antibodies. In patients with positive anti-TPO antibodies, a significant increase in total cholesterol and FBS was observed in the intervention group (p=0.02). In the third RCT, T3 in the ashwagandha group at 4 and 8 weeks significantly increased by 18.6% (p=0.012) and 41.5% (p < 0.001), respectively. A noticeable increase was found in the T4 level from baseline by 9.3% (p= 0.002) and 19.6% (p < 0.001) at 4 and 8 weeks, respectively. TSH levels fell remarkably in the intervention group compared to placebo at 4 weeks (p <0.001) and 8 weeks (p <0.001), respectively. In the last article selected, Mentha x Piperita L. showed no significant difference in fatigue scores between intervention and control groups at the midpoint (day 7), while fatigue scores improved in the intervention group in all subscales compared to the control group on day 14.

Conclusion

Some herbal remedies, including Nigella sativa L., ashwagandha, and Mentha x Piperita L., can improve the signs and symptoms of primary hypothyroidism, but using a more extensive and advanced methodology will provide us with more complete results.

Research Insights

  • Ashwagandha→Increased T3 Level

    T3 in the ashwagandha group at 4 and 8 weeks significantly increased by 18.6% (p=0.012) and 41.5% (p < 0.001), respectively.

    Effect
    Beneficial
    Effect size
    Large
  • Ashwagandha→Increased T4 Level

    A noticeable increase was found in the T4 level from baseline by 9.3% (p= 0.002) and 19.6% (p < 0.001) at 4 and 8 weeks, respectively.

    Effect
    Beneficial
    Effect size
    Moderate
  • Ashwagandha→Reduced TSH Level

    TSH levels fell remarkably in the intervention group compared to placebo at 4 weeks (p <0.001) and 8 weeks (p <0.001), respectively.

    Effect
    Beneficial
    Effect size
    Large
  • Black Seed→Increased Blood Glucose Levels

    In patients with positive anti-TPO antibodies, a significant increase in total cholesterol and FBS was observed in the intervention group (p=0.02).

    Effect
    Harmful
    Effect size
    Small
  • Black Seed→Increased T3 Level

    T3 in the ashwagandha group at 4 and 8 weeks significantly increased by 18.6% (p=0.012) and 41.5% (p < 0.001), respectively.

    Effect
    Beneficial
    Effect size
    Large
  • Black Seed→Increased Total Cholesterol Level

    In patients with positive anti-TPO antibodies, a significant increase in total cholesterol and FBS was observed in the intervention group (p=0.02).

    Effect
    Harmful
    Effect size
    Small
  • Black Seed→Reduced Blood Cholesterol

    A significant decrease in total cholesterol (CHL) and fasting blood sugar (FBS) was reported in participants with negative anti-thyroid peroxidase (anti-TPO) antibodies.

    Effect
    Beneficial
    Effect size
    Small
  • Black Seed→Reduced Body Mass Index

    and body mass index (BMI) (P=0.002)

    Effect
    Beneficial
    Effect size
    Small
  • Black Seed→Reduced Body Weight

    Nigella sativa L. caused a significant decrease in weight (P=0.004)

    Effect
    Beneficial
    Effect size
    Small
  • Black Seed→Reduced Fasting Blood Glucose Levels

    A significant decrease in total cholesterol (CHL) and fasting blood sugar (FBS) was reported in participants with negative anti-thyroid peroxidase (anti-TPO) antibodies.

    Effect
    Beneficial
    Effect size
    Small
  • Black Seed→Reduced TSH Level

    TSH levels fell remarkably in the intervention group compared to placebo at 4 weeks (p <0.001) and 8 weeks (p <0.001), respectively.

    Effect
    Beneficial
    Effect size
    Large
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