Hypothyroidism

Hypothyroidism is an underactive thyroid gland: the NICE guideline on thyroid disease defines it as inadequate production and secretion of thyroid hormones, and subclinical hypothyroidism as a level of thyroid-stimulating hormone (TSH), the pituitary hormone that drives the gland, above the reference range while free thyroxine (FT4), the main thyroid hormone, stays within it. Hashimoto's thyroiditis is the most common autoimmune thyroid disorder and the leading cause of hypothyroidism worldwide, according to a 2026 narrative review by Personius and colleagues at Tulane University. It is diagnosed and tracked by antibodies against the gland: thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TGAb). The acupuncture and moxibustion literature on these conditions is small and almost entirely Chinese, and most of its trials added needling or moxibustion, the burning of the herb mugwort on or above the skin, to levothyroxine, the standard thyroid hormone tablet, without a sham control.

Is there a Cochrane review?

No. A search of PubMed and Europe PMC in October 2026 found no Cochrane review of acupuncture or moxibustion for hypothyroidism, subclinical hypothyroidism or Hashimoto's thyroiditis. The nearest is Cochrane's 2015 review of Chinese herbal medicines for hypothyroidism by Ke and colleagues at West China Hospital, which searched to September 2014, found no randomised trial it could include, and found no ongoing registered trial. It does not cover needling or moxibustion. The two systematic reviews below are the best available synthesis, and both are limited to Hashimoto's thyroiditis.

The systematic reviews

The 2024 meta-analysis by Xiaohui Wang and colleagues at Weifang Medical University included 14 randomised trials published between 1987 and 2023, all run in China. In 10 the treated group had acupuncture or moxibustion on top of levothyroxine, and in 4 it had them instead of the drug; every control group took levothyroxine and none had sham treatment. The review pooled thyroid antibody and hormone levels: TPOAb and TGAb were lower and TSH lower with acupuncture, but the inconsistency between trials (I², the share of variation not explained by chance) ran from 90% to 99%. There was no difference in anxiety or depression scores in the 2 trials that measured them. Nine trials used no blinding, and the authors called the quality of the literature low and their results uncertain. The review did not use GRADE.

A 2026 meta-analysis with trial sequential analysis from Huzhou College in Zhejiang included 15 randomised trials published between 1992 and 2023, 11 of which appear by first author and year in the 2024 review; the group sizes in its table add up to 1,098 people. It pooled acupuncture and moxibustion trials separately against thyroid hormone alone. With acupuncture, TPOAb, TGAb and TSH were lower and FT4 higher; with moxibustion, TPOAb and TGAb were lower and the hormone levels did not differ. The authors found publication bias for several acupuncture outcomes, inconsistency between trials of 62% to 99%, and larger effects in trials of lower quality and shorter duration. Thirteen trials did not report blinding of the people measuring outcomes. They wrote that these weaknesses preclude reliable clinical recommendations. It did not use GRADE either.

Reviews that are not systematic

A 2018 narrative review by Cheng gathered 29 clinical studies with 1,757 patients from China, Italy, Korea, Macedonia and Russia across hypothyroidism, hyperthyroidism and related conditions, reported fewer symptoms and better blood tests where acupuncture was used, and asked for better-designed research. A 2026 narrative review by Piao and colleagues at Heilongjiang University of Chinese Medicine examined 12 randomised trials of Chinese medicine for hypothyroidism from the past decade, mostly herbs or herbs combined with acupuncture, and named small samples and short follow-up as limits. The Tulane review above grouped acupuncture with wet cupping, diet and supplements as additions to levothyroxine in Hashimoto's thyroiditis, and found the evidence heterogeneous, methodologically limited and often small or uncontrolled.

Trials

The Russian study, by Luzina and colleagues, is the only one found that enrolled people with subclinical hypothyroidism alone: 27 women who had come for joint and muscle pain and were found to have a raised TSH with normal thyroid hormones. They had body, ear and scalp acupuncture with scraping massage of the upper back, and 20 completed both courses. The abstract reports that TSH returned to normal and quality of life improved, and its authors proposed acupuncture as an alternative to hormone replacement; the study had no control group.

The 2012 trial by Xia and colleagues at Shanghai University of Traditional Chinese Medicine, in Chinese with an English abstract, randomised 85 people to aconite cake-separated moxibustion, moxa burned on a disc of the herb aconite laid on the skin, alongside 25 µg of levothyroxine a day, or the drug alone, for one month. The moxibustion alternated between two sets of points: CV17 (Danzhong), CV12 (Zhongwan) and CV04 (Guanyuan); and GV14 (Dazhui), BL23 (Shenshu) and GV04 (Mingmen). The authors reported a higher clinical response rate, 25% against 8%, and a higher rate of improved thyroid function, 88% against 58%, among 40 analysed in each group, while TSH and FT4 did not differ between groups. Earlier reports of moxibustion from the Shanghai Research Institute of Acupuncture, such as a 1993 study of 71 people by Hu and colleagues, described lower antibody levels after treatment; the abstract describes no control group.

The 2024 trial by Wang and colleagues at Dongzhimen Hospital in Beijing randomised 58 adults with Hashimoto's thyroiditis and hypothyroidism, all taking levothyroxine throughout, to 16 weeks of acupuncture two to three times a week or to a wait for it. Needles were threaded from LI03 (Sanjian) toward LI04 (Hegu), from LI11 (Quchi) toward LI14 (Binao) and on to LI15 (Jianyu), with shallow needling at ST09 (Renying) on the front of the neck and needling at ST36 (Zusanli). At 16 weeks TGAb was lower in the acupuncture group, TPOAb did not differ, and scores on a thyroid quality-of-life questionnaire were 3.8 points better; the quality-of-life difference had faded 16 weeks after treatment stopped. Patients and acupuncturists knew the allocation, there was no sham group, and no sample size was calculated. Of the 29 in the acupuncture group, 25 had bruising of the arm or neck at least once. Needling the neck covers the structures under points such as ST09.

The one placebo-controlled trial found is a 2024 trial of point application by Qiao and colleagues at Shandong University of Traditional Chinese Medicine, in Chinese with an English abstract. It randomised 150 people with Hashimoto's thyroiditis classed under a Chinese-medicine pattern called liver-qi stagnation to herbal patches or placebo patches for 4 weeks at CV08 (Shenque), KD01 (Yongquan), an extra point in the armpit called Yeshi, and tender points, on top of health education and conventional treatment. No measure differed between the groups, including antibody and hormone levels; the authors' conclusion that the patches lowered antibodies rests on change within the treated group. Skin allergy was the main adverse reaction, in 20% of the patch group and 11% of the placebo group. Point application describes the method.

A trial protocol from Chengdu University of Traditional Chinese Medicine, registered in March 2020, planned to randomise 284 women of child-bearing age with Hashimoto's thyroiditis to acupuncture or sham acupuncture for 12 weeks, with antibody levels as the main outcome. No results had appeared in PubMed or Europe PMC by October 2026. A 2021 case series from India described 5 people with hypothyroidism treated with acupuncture and fire cupping for three months, after which TSH was normal and their doses had been reduced; a case series has no comparison group.

What guidelines say

NICE recommends levothyroxine as first-line treatment for primary hypothyroidism. For subclinical hypothyroidism it advises considering levothyroxine when TSH is 10 mIU/litre or higher on two occasions 3 months apart, and a 6-month trial of it for adults under 65 with symptoms and a lower raised TSH. The ATA guideline by Jonklaas and colleagues concluded that levothyroxine should remain the standard of care and recommended against dietary supplements and other over-the-counter products as a treatment for hypothyroidism. The association's guidelines page still lists the 2014 document. Clinical guidelines sets out how guideline bodies treat acupuncture across conditions.

What the reviews could not settle

Neither review graded the certainty of its evidence, both drew on largely the same small Chinese trials, and both pooled mainly blood tests, with anxiety and depression scores from 2 trials, rather than symptoms, the dose of levothyroxine people needed, or whether hypothyroidism developed. Without sham-controlled needling trials, the differences against levothyroxine alone cannot be separated from attention and expectation; Sham acupuncture describes what a sham control would rule out. The one placebo-controlled trial, of herbal patches rather than needles, found no difference, and the one registered sham-controlled acupuncture trial had not reported. Subclinical hypothyroidism has a single uncontrolled study. Treatment in the reviewed trials lasted 1 to 6 months, and neither review pooled any outcome measured after it stopped. Where the trials come from discusses what the country of a trial tells a reader, and Moxibustion describes the method several of the trials used.

AcuiQ's hypothyroidism and goiter pages list the protocols individual studies prescribed, each with its citation.