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TCM combinations with methimazole may improve thyroid function indices in Graves' disease patientsTCM Combined With Methimazole Shows Promise for Graves' Disease

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Key Takeaway
Consider TCM combinations as a potential short-term adjunctive strategy for initial Graves' disease treatment.

This network meta-analysis evaluated the efficacy of various Traditional Chinese Medicine (TCM) combinations when added to methimazole (MMI) in patients with Graves' disease. The analysis included 1,317 patients and assessed thyroid function indices including FT3, FT4, TSH, TRAb, and TPOAb.

The study found that specific TCM additions ranked first for several outcomes: Modified Huagan Decoction (MHD) plus MMI ranked first for FT3 reduction (SUCRA = 93.4%) and TRAb reduction (SUCRA = 88.2%). Modified Xiaoyao Powder (MXYP) plus MMI ranked first for FT4 reduction (SUCRA = 97.3%), while Xiaoyao Powder (XYP) plus MMI ranked first for TSH regulation (SUCRA = 96.3%). Additionally, Huotan Jiangni Formula (HJF) plus MMI ranked first for TPOAb reduction (SUCRA = 100%).

A primary limitation of this analysis is the incomplete and inconsistent reporting of adverse events across the included trials. While these TCM combinations may serve as a promising short-term adjunctive strategy for initial treatment, the safety profile of these specific combinations is not fully established due to data gaps.

How this fits prior evidence

This network meta-analysis extends prior evidence that TCM formulations can improve response rates and reduce syndrome scores in Graves' disease patients. While previous findings confirmed the clinical utility of TCM in managing symptoms, this study specifically quantifies the ranking of different TCM combinations when combined with methimazole to improve thyroid function indices.

Researchers analyzed data from 1,317 patients with Graves' disease to compare different treatments. They looked at how combining specific Traditional Chinese Medicine (TCM) formulas with the standard medication, methimazole, affected thyroid levels and autoantibodies.

The analysis found that certain TCM combinations performed well in specific areas. For example, Modified Huagan Decoction combined with methimazole ranked first for reducing FT3 and TRAb levels. Other combinations, like Modified Xiaoyao Powder and Huotan Jiangni Formula, also showed strong results in regulating TSH and lowering TPOAb levels.

While these findings suggest that TCM could be a helpful addition to standard care during initial treatment, there is an important caution. The study noted that safety data was inconsistent across the reports. Because of this incomplete information, the long-term safety of these specific combinations is not fully established. Patients should talk to their doctors about how these options might fit into their personal treatment plan.

What this means for you:
TCM combined with methimazole may help manage Graves' disease symptoms, but more safety data is needed.

Common questions

How does TCM combined with methimazole compare to methimazole alone?

The study found that specific Traditional Chinese Medicine formulas, when added to methimazole, ranked first in several categories. These included reducing FT3 and TRAb levels, as well as improving TSH regulation and lowering TPOAb levels compared to other options.

Is it safe to use TCM with my thyroid medication?

The study noted that safety data for these combinations is not fully established because reporting was inconsistent across different trials. You should consult your doctor before adding any new supplements or herbal treatments to your current medication.

What specific results were seen in the study?

The analysis showed that Modified Huagan Decoction plus methimazole ranked first for FT3 and TRAb reduction. Other combinations, like Modified Xiaoyao Powder and Huotan Jiangni Formula, also showed high rankings for improving TSH and TPOAb levels.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
Traditional Chinese Medicine (TCM) Combined with Methimazole (MMI) versus MMI Alone for Thyroid Function and Autoantibodies in Graves’ Disease(GD). A systematic literature search was performed in PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, VIP, CBM, and Wanfang databases up to June 2025 for RCTs comparing TCM plus MMI versus MMI alone. Study risk of bias was evaluated using the Cochrane tool. We assessed transitivity to ensure intervention comparability, verified consistency via node-splitting analysis, and planned sensitivity analysis according to risk-of-bias classification. A network meta-analysis was conducted in Stata 15.1 using a random-effects model. Results are reported as mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI), and treatment efficacy was ranked using SUCRA values. A network meta-analysis of 15 RCTs involving 1,317 GD patients and 14 TCM plus MMI regimens showed potential advantages over MMI alone in improving thyroid function indices and reducing selected autoantibodies, particularly TRAb and TPOAb. Adverse events were summarized descriptively because AE reporting was incomplete and heterogeneous across the included RCTs. Regarding SUCRA rankings, the Modified Huagan Decoction (MHD) + MMI ranked first for reducing FT3 (SUCRA = 93.4%), the Modified Xiaoyao Powder (MXYP) + MMI ranked first for reducing FT4 (SUCRA = 97.3%), and the Xiaoyao Powder (XYP) + MMI ranked first for regulating TSH (SUCRA = 96.3%). For decreasing TRAb, the MHD + MMI regimen ranked first (SUCRA = 88.2%), while for lowering TPOAb, the Huotan Jiangni Formula (HJF) + MMI showed the highest SUCRA ranking (SUCRA = 100%). TCM combined with MMI may have beneficial effects on thyroid function and selected autoantibody levels, particularly TRAb and TPOAb, in GD patients versus MMI alone. Among the evaluated regimens, MHD + MMI, MXYP + MMI, XYP + MMI, and HJF + MMI showed high SUCRA rankings for specific outcomes, including FT3, FT4, TSH, TRAb, and TPOAb. These findings suggest that TCM plus MMI may be a promising short-term adjunctive strategy for initial GD treatment, although safety evidence remains limited by incomplete and inconsistent AE reporting. https://www.crd.york.ac.uk/prospero/, identifier CRD420251151307.
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