---
title: "Hyperthyroidism"
url: "https://acuiq.com/wiki/evidence/hyperthyroidism"
updated: 2026-10-14
last_verified: 2026-10-14
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-14"
reading_minutes: 9
sources: 17
---

# Hyperthyroidism

_What the Cochrane Library, reviews, small trials and the ATA, ETA, EUGOGO and Chinese guidelines report on acupuncture, pricking and electroacupuncture for hyperthyroidism, Graves' disease and thyroid eye disease._

Hyperthyroidism is an overactive thyroid gland: the [2007 Cochrane review of Chinese herbal medicines for hyperthyroidism](https://doi.org/10.1002/14651858.CD005450.pub2) describes it as excessive thyroid hormone in the blood, with a fast heart rate ([tachycardia](/symptoms/tachycardia)), warm moist skin and raised body temperature among its signs. Graves' disease is an autoimmune cause of it, and it can involve the eyes as well: thyroid eye disease, also called Graves' ophthalmopathy or orbitopathy, is an autoimmune disease of the tissue around the eyes whose signs include bulging eyes, which the trials call exophthalmos. The acupuncture literature on these conditions is small and mostly Chinese. Most of its trials added needling to methimazole, the standard antithyroid drug, or set needling against drugs, and none of those described here compared it with sham acupuncture, a procedure made to resemble it.

## Is there a Cochrane review?

No. A search of PubMed and the Cochrane Library in October 2026 found no Cochrane review, and no systematic review or meta-analysis in any journal, of acupuncture for hyperthyroidism, Graves' disease or thyroid eye disease. The nearest Cochrane review is the herbal one above, by Zen and colleagues, which included 13 trials with 1,770 participants, all of low quality, and found that herbs added to antithyroid drugs may lower relapse rates and adverse effects; it could identify no well-designed trial and recommended no preparation. It does not cover needling. Cochrane's [2010 review of antithyroid drug regimens](https://doi.org/10.1002/14651858.CD003420.pub4) by Abraham and colleagues, 26 trials with 3,388 participants, sets the background any added treatment would be measured against: in the 12 trials that compared two common regimens, hyperthyroidism returned in 51% and 54% of people after the course of drugs.

## Reviews that are not systematic

Three papers survey the field without pooling it. A [2018 narrative review](https://doi.org/10.1016/j.joim.2018.09.002) by Cheng gathered 29 clinical studies with 1,757 patients aged 7 to 79 from China, Italy, Korea, Macedonia and Russia, covering hyperthyroidism, [hypothyroidism](/symptoms/hypothyroidism) and related conditions together. It reported fewer symptoms and better blood tests where acupuncture was used alone or with other treatment, and asked for better-designed research to give reliable data.

A [2019 survey of Chinese prescriptions](https://doi.org/10.13703/j.0255-2930.2019.06.028) by Wang and Ning, in Chinese with an English abstract, counted the points in 46 papers from the CNKI, VIP and Wanfang databases. For hyperthyroidism the six points prescribed most often were [`SP06`](/points/sp06) (Sanyinjiao), [`PC06`](/points/pc06) (Neiguan), [`ST36`](/points/st36) (Zusanli), [`ST10`](/points/st10) (Shuitu), on the front border of the large muscle at the side of the neck, [`LI04`](/points/li04) (Hegu) and [`LV03`](/points/lv03) (Taichong), which the paper writes LR 3. For bulging eyes they were [`GB20`](/points/gb20) (Fengchi), an extra point called Shangtianzhu, `LI04`, `SP06`, [`BL02`](/points/bl02) (Cuanzhu) and [`GB14`](/points/gb14) (Yangbai). The authors wrote that the field lacks a simple method that can be adopted widely. A count of how often points appear shows what Chinese clinicians prescribe, not which prescriptions were tested against a control.

A [2026 narrative review](https://doi.org/10.2147/IJGM.S625971) by Liu and colleagues of traditional Chinese medicine as an addition to standard hyperthyroidism care found that clinical use combines therapies, and that acupuncture on its own is uncommon. Its one acupuncture trial, a 2022 study by Wang and Liu, gave 53 people with primary hyperthyroidism a herbal decoction, acupuncture and methimazole and 54 methimazole-based routine care, and reported better symptoms, blood tests and quality of life and fewer relapses within 12 months. The reviewers noted that the sample was small, remission was not defined in advance, and 12 months is too short to judge relapse after the drug stops. Because herbs and needles were given together, the trial cannot attribute any difference to either. The review rated the overall certainty of the evidence limited.

## Trials

| Trial | Condition | People | Comparison | What the abstract reports |
| --- | --- | --- | --- | --- |
| Rogvi-Hansen 1991, Denmark | Graves' ophthalmopathy, thyroid function normal for at least a year | 17 | Not named in the abstract | No significant change in eye muscle volume, eye protrusion or eye movement |
| Li 2006, Dongguan | Graves' disease | 60 | Pricking against methimazole | Response 93% against 77%; larger fall in T3 and receptor antibodies |
| Xia 2010, Shanghai | Hyperthyroid eye disease | 52 | Acupuncture added to methimazole and levothyroxine, against the drugs alone | Larger improvement in eye-sign scores; bleeding or bruising at needle sites in 16 cases |
| Xu 2011, Longhai | Infiltrative exophthalmos | 45 | Acupuncture and massage against steroids and methotrexate | Protrusion fell from 20.3 to 18.1 mm, against 20.3 to 19.5 mm |

The Danish trial, by [Rogvi-Hansen and colleagues at Herlev Hospital](https://doi.org/10.1530/acta.0.1240143), was published in Acta Endocrinologica in 1991 and called itself blinded and randomised. Its patients had acupuncture twice a week for two months; an ophthalmologist examined them and computed tomography measured the eye muscles. The abstract does not say what the comparison group received or who was blinded, and only the abstract is openable.

The three Chinese trials are published in Chinese in the journal Zhongguo Zhen Jiu, and only their English abstracts are openable. In the [2006 trial](https://pubmed.ncbi.nlm.nih.gov/17165495/) by Li and colleagues, pricking meant puncturing a point the authors called the thyroid high point, and the control group took methimazole, which the abstract calls by its brand name, Tapazole. The response rate is the share of patients the authors classed as improved. The [2010 trial](https://pubmed.ncbi.nlm.nih.gov/21058474/) by Xia and colleagues at Shanghai Changhai Hospital needled points around the eye, including [`BL01`](/points/bl01) (Jingming), [`ST01`](/points/st01) (Chengqi) and [`TB23`](/points/tb23) (Sizhukong), while both groups took thiamazole, another name for methimazole, and levothyroxine. In the drug-only group 4 people developed a low white cell count, 3 a rash and 3 worse eye protrusion; in the acupuncture group the authors recorded no drug side effects but 8 cases of bleeding and 8 of haematoma, a bruise under the skin. In the [2011 trial](https://pubmed.ncbi.nlm.nih.gov/21442804/) by Xu and colleagues the comparison was intravenous dexamethasone and methotrexate with oral prednisone, and its response figures use denominators of 48 and 39, which do not match the 25 and 20 patients randomised. None of the three describes a sham group or blinded assessment in its abstract.

A [2017 case report](https://doi.org/10.4103/0366-6999.211546) from the First Affiliated Hospital of Harbin Medical University described electroacupuncture with needles inserted about 20 mm into the orbit, along the eye muscles, in one man with thyroid eye disease who had declined surgery and continued methimazole and levothyroxine. His eye score improved over four 15-day courses, while the swelling of his eyelids and the protrusion of his eyes did not change. A [trial protocol](https://doi.org/10.1097/MD.0000000000023734) from Longhua Hospital in Shanghai, registered in November 2020, planned to randomise 120 people with inactive thyroid eye disease to a herbal decoction, acupuncture or both for 12 weeks on top of standard drugs. No results had appeared in PubMed or Europe PMC by October 2026. [Reading an acupuncture trial](/wiki/research/reading-an-acupuncture-trial) explains what a protocol commits a trial to.

## What guidelines say

| Guideline | Published | Mentions acupuncture |
| --- | --- | --- |
| American Thyroid Association, hyperthyroidism | August 2016 | No |
| European Thyroid Association, Graves' hyperthyroidism | July 2018 | No |
| EUGOGO, Graves' orbitopathy | August 2021 | No |
| ATA and ETA consensus, thyroid eye disease | December 2022 | No |
| Chinese Medical Association, thyroid eye disease | 2022 | Yes, as an adjunct |

The [ATA guideline](https://doi.org/10.1089/thy.2016.0229) by Ross and colleagues recommends radioactive iodine, antithyroid drugs or surgery for overt Graves' hyperthyroidism. It cites the Cochrane herbal review in its reference list but makes no recommendation on herbs or acupuncture. The association's [guidelines page](https://www.thyroid.org/professionals/ata-professional-guidelines/) still lists the 2016 document as its hyperthyroidism guideline. The [ETA guideline](https://doi.org/10.1159/000490384) by Kahaly and colleagues recommends antithyroid drugs first for newly diagnosed Graves' disease, with methimazole for 12 to 18 months. For thyroid eye disease, the [EUGOGO guideline](https://doi.org/10.1530/EJE-21-0479) by Bartalena and colleagues for the European Group on Graves' Orbitopathy and the [ATA and ETA consensus statement](https://doi.org/10.1089/thy.2022.0251) by Burch and colleagues recommend selenium, steroids, other immune-suppressing drugs, newer antibody drugs, radiotherapy and surgery according to severity and activity.

A [2026 comparison of the three thyroid eye disease guidelines](https://doi.org/10.1007/s40123-026-01326-z) by Lei and colleagues reports that the Chinese Medical Association's 2022 guideline lists traditional Chinese medicine and acupuncture as an optional adjunct for moderate-to-severe disease. The comparison notes that high-quality evidence for them remains limited. Its only acupuncture citation is the Longhua protocol above, which had not reported. [Clinical guidelines](/wiki/evidence/clinical-guidelines) sets out how guideline bodies treat acupuncture across conditions.

## What the reviews could not settle

No review has pooled the acupuncture trials, so there is no estimate of effect and no certainty rating for any outcome. The trials that exist are small, and the Chinese ones compare needling with drugs or add it to drugs without a sham group, so nothing separates the needling from attention and expectation; [Sham acupuncture](/wiki/research/sham-acupuncture) describes what a sham control would rule out. The one trial that may have used a blinded control reported no change in the eyes. Relapse after the drugs stop was reported only in the 2022 trial and only for 12 months. Needling around the eye produced bleeding and bruising in one trial, and no trial was large enough to judge rarer harms. [Where the trials come from](/wiki/research/where-the-trials-come-from) discusses what the country of a trial tells a reader.

AcuiQ's [hyperthyroidism page](/symptoms/hyperthyroidism) lists the protocols individual studies prescribed, each with its citation.

### Sources

1. Zen XX, Yuan Y, Liu Y, Wu TX, Han S, Chinese herbal medicines for hyperthyroidism, Cochrane Database of Systematic Reviews 2007, CD005450.pub2 — https://doi.org/10.1002/14651858.CD005450.pub2
2. Abraham P, Avenell A, McGeoch SC, Clark LF, Bevan JS, Antithyroid drug regimen for treating Graves' hyperthyroidism, Cochrane Database of Systematic Reviews 2010, CD003420.pub4 — https://doi.org/10.1002/14651858.CD003420.pub4
3. Cheng FK, An overview of the contribution of acupuncture to thyroid disorders, Journal of Integrative Medicine 2018 — https://doi.org/10.1016/j.joim.2018.09.002
4. Wang GA, Ning RX, Acupoint selection rules of hyperthyroidism and related exophthalmos treated with acupuncture (in Chinese), Zhongguo Zhen Jiu 2019 — https://doi.org/10.13703/j.0255-2930.2019.06.028
5. Liu Z, Chen C, Yu S, et al., Traditional Chinese medicine as an adjunct in hyperthyroidism management: a narrative review of pathophysiology, proposed mechanisms, and clinical evidence, International Journal of General Medicine 2026 — https://doi.org/10.2147/IJGM.S625971
6. Rogvi-Hansen B, Perrild H, Christensen T, Detmar SE, Siersbaek-Nielsen K, Hansen JE, Acupuncture in the treatment of Graves' ophthalmopathy: a blinded randomized study, Acta Endocrinologica 1991 — https://doi.org/10.1530/acta.0.1240143
7. Li GL, Zhou ZX, Li JM, Observation on therapeutic effect of picking therapy on Graves' disease (in Chinese), Zhongguo Zhen Jiu 2006 — https://pubmed.ncbi.nlm.nih.gov/17165495/
8. Xia Y, Shu S, Li Y, Liu SM, He JS, Therapeutic effect and side effect of treatment on hyperthyroid exophthalmos with the combination of acupuncture and medication (in Chinese), Zhongguo Zhen Jiu 2010 — https://pubmed.ncbi.nlm.nih.gov/21058474/
9. Xu WM, Guo YH, Chen BX, Efficacy observation on infiltrative exophthalmos treated with acupuncture and acupoint massage (in Chinese), Zhongguo Zhen Jiu 2011 — https://pubmed.ncbi.nlm.nih.gov/21442804/
10. Zhou LY, Su C, Li XM, Liu TJ, Zhao M, Intraorbital electroacupuncture therapy for thyroid-associated ophthalmopathy, Chinese Medical Journal 2017 — https://doi.org/10.4103/0366-6999.211546
11. Li H, Zheng P, Min J, et al., A prospective randomized controlled clinical trial of Pingmu Decoction combined with acupuncture in the treatment of non-active thyroid-related ophthalmopathy (protocol), Medicine 2020 — https://doi.org/10.1097/MD.0000000000023734
12. Ross DS, Burch HB, Cooper DS, et al., 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis, Thyroid 2016 — https://doi.org/10.1089/thy.2016.0229
13. American Thyroid Association, ATA professional guidelines (accessed October 2026) — https://www.thyroid.org/professionals/ata-professional-guidelines/
14. Kahaly GJ, Bartalena L, Hegedüs L, Leenhardt L, Poppe K, Pearce SH, 2018 European Thyroid Association guideline for the management of Graves' hyperthyroidism, European Thyroid Journal 2018 — https://doi.org/10.1159/000490384
15. Bartalena L, Kahaly GJ, Baldeschi L, et al., The 2021 European Group on Graves' orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves' orbitopathy, European Journal of Endocrinology 2021 — https://doi.org/10.1530/EJE-21-0479
16. Burch HB, Perros P, Bednarczuk T, et al., Management of thyroid eye disease: a consensus statement by the American Thyroid Association and the European Thyroid Association, Thyroid 2022 — https://doi.org/10.1089/thy.2022.0251
17. Lei C, Jin J, Li R, et al., Management of thyroid eye disease: a comparison between three recent clinical guidelines, Ophthalmology and Therapy 2026 — https://doi.org/10.1007/s40123-026-01326-z