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Acupuncture and Traditional Chinese Medicine for Thyroid Health

by Jillian L. Capodice, LAc

The thyroid’s fitting name comes from the Greek thyreos and eidos (shield and form respectively). The thyroid is a highly vascular organ that coordinates the metabolism of almost all cells in the body based on the uptake of iodine, combination with tyrosine, and subsequent conversion to T3 and T4 hormones. The role of T3 and T4 are then control many metabolic reactions.  Moreover, the thyroid axis is a wonderful example of a classic endocrine system feedback loop.  In short, its hypothalamic-pituitary-organ signaling occurs due to cross-talk between the thyroid hormones T3 and T4, feedback of thyrotropin-releasing hormone (TRH), and pituitary production of thyroid-stimulating hormone (TSH). 1 

Consequently the biomedical disorders of the thyroid range from disruptions in its hypothalamic-pituitary-organ axis (e.g.: hypothyroidism, thyrotoxicosis (e.g.: hormone excess most frequently caused by Graves’ disease, hyperthyroidism and adenomas), morphologic dysfunction of the thyroid (e.g: benign disease, thyroid cancer, goiter, nodular dysfunction), and sick euthyroid syndrome (caused by almost any type of acute severe illness in the absence of underlying thyroid disease). 1

Thyroid Health

 

 

 

 

 

 

 

 

 



What is the role/realtionship of the thyroid in Traditional Oriental and Chinese Medicine?

Of the literature I surveyed there is very little discussion of the thyroid organ in classic textbooks of Chinese Medicine and it is likely that the thyroid organ may not have been classically named or discussed with regard to specific zang-fu pathophysiology.  However constellations of symptoms and signs that closely correlate to those of the present hypothyroid and hyperthyroid  are listed in table 1.  However as practitioners of traditonal Oriental Medicine (TOM) and acupuncture know, diagnosis is based on TCM/OM tenets of diagnosis.  This is reflected in current text books were hypo- and hyper-thyroidism are often listed as potential biomedical differentials when describing the treatment of shared common symptoms such as fatigue or tiredness (xu lao). 2   

Table 1

Biomedical diagnosis                                              TCM

Dx: Hyperthyroid

 Etiology (not all inclusive): Grave’s disease, toxic multinodular goiter, thyroid carcinoma, toxic adenoma, iodine excess

 Common symptoms:

  1. irritability and hyperactividy
  2. intolerance to heat
  3. excessive sweating
  4. palpitations
  5. increased appetite and weight loss
  6. diarrhea
  7. fatigue

Common signs:

  1. tachycardia
  2. goiter
  3. warm and clammy skin
  4. muscle weakness and tremor
  5. ophthalmopathy

Common labs:

  1. TSH
  2. T4 and T3

Some common dx related to hyperthyroid disease:

  1. qi stagnation
  2. phelgm accumulation with heat
  3. yin defeceincey
  4. various combination pathologies

Common symptoms:

  1. irritability and hyperactividy
  2. intolerance to heat
  3. excessive sweating
  4. palpitations
  5. increased appetite and weight loss
  6. diarrhea
  7. fatigue

Common signs:

  1. goiter
  2. warm and clammy skin
  3. rapid or loud speech
  4. scattered shen
  5. muscle tightness or weakness on palpation
  6. Common tongues:  puffy, red, peeled, swollen, dusky
  7. Common pulses:  rapid, floating, thready, weak,  hollow

 

Dx: Hypothyroid

Etiology (not all inclusive): iodine defeciency, congenital abnormalitites, autoimmune hypothyroidsm (c/ or s/goiter)

  Common symptoms:

 - fatigue, weakness

 - dry skin

 - cold feeling or extremeties

 - poor appetite despite weight gain

 - hair loss

 - difficulty breathing

 - constipation

 - mennorhagia or amenorrhea

Common signs:

  1. dry and coarse skin
  2. cool peripheral extremities
  3. edema or puffy skin
  4. alopecia
  5. bradycardia

Common labs:

  1. TSH
  2. T4
  3. thyroid peroxidase antibodies

Some common dx related to hypothyroid disease:

  1. qi stagnation
  2. phelgm accumulation with cold
  3. yang defeceincey
  4. various combination pathologies

Common symptoms:

 -  fatigue, weakness

 -  dry skin

 -  cold feeling or extremeties

 -  poor appetite despite weight gain

 -  hair loss

 -  difficulty breathing

 -  constipation

 -  mennorhagia or amenorrhea

Common signs:

  1. dry, coarse, pale skin
  2. cool skin on palpation
  3. edema or puffiness
  4. alopecia
  5. lethargic shen
  6. Common tongues:  puffy, pale, scalloped, swollen, often dusky
  7. Common pulses:  slow, deep, weak chi and or cun, floating, thready

While clinical case reports and clincial experience enable me to recommend TCM and acupuncture as part of a  succesful integrative treatment plan or stand-alone treatment (mild and/or refractory symptoms) for many symptoms and particularly those experienced in hypothyrodism, only a fraction of research exists in the literature that examine acupuncture or related TOM modaltities (such as herbal medicine or qi gong) for hypo- or hyper-thyroidsim.  There were no studies found on testing the potential effect of acupuncture for thyroid symptoms but interestingly, there were a number of studies and case reports about acupucnture analgesia use during thyroid procedures and/or thyroidectomies. 

As far as herbal research goes there were also limited studies on the effect of Chinese herbs on thyroid symptoms and/or thyroid cancer.  The only recent study published was one on a small molecual triptolide from the herb Tripterygium wilfordii (lei gong teng).  The investigators demonstrated the ability of the triptolide component to inhibit cell growth and modulate expression of NF-kappaB transcriptional activity (and subsequent targets) in the human cancer cell-line TAK-ATC (derived from an anaplastic thryoid carcinoma). 5  Two Chinese studies published prior to 1990 look at the effect of yang-restoring herbal formulas in rats and their effect on hormone levels although these studies were methodolocially poor and do not seem to have been followed up on. 6,7

Finally the only recent study I wanted to highlight is not relative to the treatment of thyroid symptoms.  Instead it is related to a theoretical model of musculoskeletal pain based on thyroid associated ophthalmopathy.  It ultimately is a study of interest to anyone practicing acupuncture because the main objective was to use magnetic resonance imaging to demonstrate potential tangible location/association of the extraordinary meridians yang qiao mai, yin qiao mai and dai mai to muscles and their traditionally outlined pathways. See below for the brief outline.

Moncayo R, Rudisch A, Kremser C, Moncayo H. 3D-MRI rendering of the anatomical structures related to acupuncture points of the Dai mai, Yin qiao mai and Yang qiao mai meridians within the context of the WOMED concept of lateral tension: implications for musculoskeletal disease. BMC Musculoskelet Disord. 2007 Apr 10;8:33. 4

Objective: To characterize the anatomical structures related to acupuncture points in a conceptual model of lateral muscular tension in patients with thyroid associated ophthalmopathy via 3D MRI imaging.

Methods: Single subject with lateral pain based on a previously characterized model called the “WOMED concept of lateral tension” (which includes foot inversion, eccentric muscle position of the shank, calf and hip, head falling to the side) was subject to imaging of acupuncture points on the yin qiao mai (kidney points), yang qiao mai (bladder points), dai mai (liver and gall bladder points)

Intervention: Location of points Kidney 3, Kidney 6, the plantar Kidney 6 (Nan jing description), Bladder 62, Bladder 59, Bladder 61, and the plantar Bladder 62 (Nan jing description), Liver 13, Gall bladder 26, Gall bladder 27, Gall bladder 28, and Gall bladder 29 were marked by taping a nitro-glycerin capsule on the skin and MR imaging was subsequently obtained and analyzed. 

Outcomes:      

  • Points of the Yin qiao mai meridian – at the medial side of the ankle – corresponded to tendinous structures of the flexor digitorum longus as well as to muscular structures of the abductor hallucis on the foot sole

§  Points of the Dai mai meridian – at the level of the waist – corresponded to the obliquus externus abdominis and the obliquus internus abdominis

§  Points of the Yang qiao mai meridian – at the lateral side of the ankle – corresponded to tendinous structures of the peroneus brevis, the peroneous longus, and the lateral surface of the calcaneus and close to the foot sole to the abductor digiti minimi

Conclusion: These investigators conclude that MRI investigation demonstrated the anatomic relations of traditional acupuncture points that are categorized as important points on three of the eight extraordinary meridians. 

Comments: While this study had nothing to do with treatment for symptoms related to hyperthyroidism and/or ophthalmopathy (TAO), the authors speculate that the WOMED concept of lateral tension is present and may play a role in TAO.4

References

1.  Harrison’s Principles of Internal Medicine.  Accessed on access medicine at http://www.accessmedicine.com/content.aspx?aID=2888510.  Viewed January 26, 2009

2.  Macciocia G, The Foundations of Chinese Medicine.  Churchill Livingston, 1997.

3.  Moncayo R, Rudisch A, Kremser C, Moncayo H. 3D-MRI rendering of the anatomical structures related to acupuncture points of the Dai mai, Yin qiao mai and Yang qiao mai meridians within the context of the WOMED concept of lateral tension: implications for musculoskeletal disease. BMC Musculoskelet Disord. 2007 Apr 10;8:33. 

4.  Moncayo R, Moncayo H: A musculoskeletal model of low grade connective tissue inflammation in patients with thyroid associated ophthalmopathy (TAO): the WOMED concept of lateral tension and its general implications in disease. BMC Musculoskelet Disord 2007, 8:17.

5. Zhu W, Ou Y, Li Y, Xiao R, Shu M, Zhou Y, Xie J, He S, Qiu P, Yan G.A Small Molecule Triptolide Suppresses Angiogenesis and Invasion of Human Anaplastic Thyroid Carcinoma Cells via Down-regulation of NF-{kappa}B Pathway. Mol Pharmacol. 2009 Jan 21. [Epub ahead of print]

6. Kuang AK, Chen JL, Chen MD. Effects of yang-restoring herb medicines on the levels of plasma corticosterone, testosterone and triiodothyronine. Zhong Xi Yi Jie He Za Zhi. 1989 Dec;9(12):737-8, 710. Chinese.

7. Chen MD, Kuang AK, Chen JL. Influence of yang-restoring herb medicines upon metabolism of thyroid hormone in normal rats and a drug administration schedule.  Zhong Xi Yi Jie He Za Zhi. 1989 Feb;9(2):93-5, 70. Chinese.


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