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Case report – Acupuncture treatment in subclinical hypothyroidism

Authors:
  • Center of Traditional Chinese Medicine "Tong Da Tang" Skopje
  • Center of Traditional Chinese Medicine "Tong Da Tang" Skopje

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Subclinical hypothyroidism is a term used to define a stage of hypothyroidism which appears most commonly in the early stages of the disease. When blood analysis are done, they show increased thyrotropin-stimulating hormone (TSH) levels and normal free thyroxine (T4) levels. The aim of the acupuncture treatment is to help the patient’s own body ability to awaken to naturally heal and help reduce the body's stress response, so to improve the thyroid function. In the article is presented a case of 46 year old woman, diagnosed with subclinical hypothyroidism for one year. The patient has made 11 acupuncture treatments in a period of 3 months. Before the treatment the TSH level was 9.19 mIU/L (ref. 0.465-4.68), during the treatment it decreased to 3.70 mIU/L and after the treatment it normalized to 3.09 mIU/L. Acupuncture points used in the treatment are: DU4 (MingMen), RN4 (QuanYuan), RN6 (QiHai), GB20 (FengChi), DU20 (BaiHui), BL15 (XinShu), DU14 (DaZhui), LI4 (HeGu), ST9 (RenYing), LR2 (TaiChong), BL20 (PiShu), BL23 (ShenShu), SP6 (SanYinJiao), SP9 (YinLingQuan), ST36 (ZuSanLi), KI3 (TaiXi) and Ashi points located on the neck (front and back). Acupuncture treatment as part of the TCM, gives fast and promising results in a short manner of time, improving the thyroid function and the overall body function and energy.
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JCBPS; Section B; May 2021 July 2021, Vol. 11, No. 3; 520-523. E- ISSN: 2249 1929
[DOI: 10.24214/jcbps.B.11.3.520-523.]
Journal of Chemical, Biological and Physical Sciences
An International Peer Review E-3 Journal of Sciences
Available online atwww.jcbsc.org
Section B: Biological Sciences
CODEN (USA): JCBPAT Case report
520
JCBPS; Section B; May 2021 July 2021, Vol. 11, No. 3; 520-523.
[DOI:10.24214/jcbps.B.11.3.52023.]
Case report Acupuncture treatment in subclinical
hypothyroidism
Blagica Arsovska1, 2, Jihe Zhu1 and Kristina Kozovska1, 3
1 Faculty of Medical Sciences, University Goce Delchev, Shtip, Republic of Macedonia;
2 Institute of Biology, Faculty of Natural Sciences and Mathematics, Skopje, Republic of Macedonia
3 Medicine Faculty, St. Cyril and Methodius University of Skopje, Republic of Macedonia
Received: 15 June 2021; Revised: 24 June 2021; Accepted: 30 June 2021
Abstract: Subclinical hypothyroidism is a term used to define a stage of hypothyroidism
which appears most commonly in the early stages of the disease. When blood analysis are
done, they show increased thyrotropin-stimulating hormone (TSH) levels and normal free
thyroxine (T4) levels. The aim of the acupuncture treatment is to help the patient’s own
body ability to awaken to naturally heal and help reduce the body's stress response, so to
improve the thyroid function. In the article is presented a case of 46 year old woman,
diagnosed with subclinical hypothyroidism for one year. The patient has made 11
acupuncture treatments in a period of 3 months. Before the treatment the TSH level was
9.19 mIU/L (ref. 0.465-4.68), during the treatment it decreased to 3.70 mIU/L and after the
treatment it normalized to 3.09 mIU/L. Acupuncture points used in the treatment are: DU4
(MingMen), RN4 (QuanYuan), RN6 (QiHai), GB20 (FengChi), DU20 (BaiHui), BL15
(XinShu), DU14 (DaZhui), LI4 (HeGu), ST9 (RenYing), LR2 (TaiChong), BL20 (PiShu),
BL23 (ShenShu), SP6 (SanYinJiao), SP9 (YinLingQuan), ST36 (ZuSanLi), KI3 (TaiXi)
and Ashi points located on the neck (front and back). Acupuncture treatment as part of the
Case report Blagica Arsovska et al.
521
JCBPS; Section B; May 2021 July 2021, Vol. 11, No. 3; 520-523.
[DOI:10.24214/jcbps.B.11.3.52023.]
TCM, gives fast and promising results in a short manner of time, improving the thyroid
function and the overall body function and energy.
Key words : hypothyroidism, acupuncture, traditional Chinese medicine, thyroid
INTRODUCTION
Subclinical hypothyroidism is a term used to define a stage of hypothyroidism which appears most
commonly in the early stages of the disease. When blood analysis are done, they show increased
thyrotropin-stimulating hormone (TSH) levels and normal free thyroxine (T4) levels. The condition may
remain unchanged or it may progress with detectable anti-thyroid antibodies and greater TSH elevated
levels. The condition appears in 3% to 8% of the population and most commonly in women than in men.
Some studies have shown that 26.8% of the patients diagnosed with subclinical hypothyroidism have
developed full-blown hypothyroidism within 6 years of the initial diagnosis [1-3].
Risk factors for developing a thyroid disease are: family history of thyroid diseases, radiation treatments,
auto-immune diseases, presence of anti-thyroid antibodies, medications, old age and other [1].
The clinical signs and symptoms of hypothyroidism usually manifest when the disease is fully developed,
but one or more symptoms may be also present in the earliest (subclinical) stage. Signs and symptoms of
hypothyroidism are: fatigue, weakness, muscle cramps, weight gain, brittle nails, edema, cold intolerance,
dry skin, hair loss, depression, constipation, bradycardia and other. In some patients with subclinical
hypothyroidism are found elevated levels of total cholesterol, low-density lipoprotein (LDL) cholesterol
and triglycerides, pointing that there is a possible connection between the subclinical hypothyroidism and
cardiovascular diseases, causing high blood pressure and high cholesterol [1,3].
The Western medicine as a treatment for clinical hypothyroidism recommends low daily dosages of
levothyroxine - 25 to 50 mg for six to eight weeks. The goal of the treatment is to maintain the TSH level
within normal range [1].
The traditional Chinese medicine (TCM) as a treatment for clinical hypothyroidism recommends
acupuncture, moxibustion and herbal treatment. Due to the nature of the condition, these treatments are
usually long-term. The aim of these treatments is to help the patient’s own body ability to awaken to
naturally heal and help reduce the body's stress response, so to improve the thyroid function [4,5].
CASE REPORT
In the article is presented a case of 46 year old woman, diagnosed with subclinical hypothyroidism for one
year. The patient’s symptoms were fatigue, irregular menstrual cycle, elevated platelets, triglycerides, and
cholesterol and decreased hemoglobin. The patient was prescribed to take Eutirox, 50 mg per day. The
patient was taking the medications during the acupuncture treatments too.
The patient has made 11 acupuncture treatments in a period of 3 months. In that period were made 3 blood
test analyses, before, during and after the treatments. Before the treatment the TSH level was 9.19 mIU/L
Case report Blagica Arsovska et al.
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JCBPS; Section B; May 2021 July 2021, Vol. 11, No. 3; 520-523.
[DOI:10.24214/jcbps.B.11.3.52023.]
(ref. 0.465-4.68), during the treatment it decreased to 3.70 mIU/L and after the treatment it normalized to
3.09 mIU/L. The other parameters were normal. The same results are shown in table 1.
Table 1: Blood test analysis done before, during and after the treatment
TSH (0.465-4.68 mIU/L)
fT4 (9-20 pmol/L)
Before treatment
9.19
11.51
During treatment
3.70
/
After treatment
3.09
14.41
The acupuncture treatments were made in a clinic for acupuncture and TCM in Skopje, North Macedonia
by a doctor specialist in acupuncture. Treatments were done once a week, with duration of 30-45 minutes
each side of the body. Treatments were done indoor, on a room temperature. In the treatment were used
fine sterile disposable needles sized 0.25x25 mm produced by Wuijuiang City Medical & Health Material
Co., LTD.
Acupuncture points used in the treatment are: DU4 (MingMen), RN4 (QuanYuan), RN6 (QiHai), GB20
(FengChi), DU20 (BaiHui), BL15 (XinShu), DU14 (DaZhui), LI4 (HeGu), ST9 (RenYing), LR2
(TaiChong), BL20 (PiShu), BL23 (ShenShu), SP6 (SanYinJiao), SP9 (YinLingQuan), ST36 (ZuSanLi),
KI3 (TaiXi) and Ashi points located on the neck (front and back).
Hypothyroidism, in terms of TCM, is mainly a deficiency disorder i.e. chronic deficiency of some of the
vital substances of the body blood, Qi, Yang, Yin or Essence. The condition may affect all the organs,
but mainly affected are Kidney, Spleen and Heart, and indirectly Lungs and Liver. The beginning stage of
the condition (the subclinical hypothyroidism) is mainly present with symptoms of Spleen Qi deficiency.
The acupuncture treatment is most effective at the onset of the disease and gives best results in early-stage
conditions like subclinical hypothyroidism [6,7].
CONCLUSION
Acupuncture treatment as part of the Traditional Chinese Medicine, gives fast and promising results in a
short manner of time, improving the thyroid function and the overall body function and energy.
REFERENCES
1. V. Adlin, Subclinical Hypothyroidism: Deciding When to Treat; Am Fam Physician. 1998 Feb 15;
57(4):776-780.
2. V. Fatourechi; Subclinical Hypothyroidism: An Update for Primary Care Physicians; Mayo Clin
Proc. 2009 Jan; 84(1): 6571.
Case report Blagica Arsovska et al.
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JCBPS; Section B; May 2021 July 2021, Vol. 11, No. 3; 520-523.
[DOI:10.24214/jcbps.B.11.3.52023.]
3. D. Christiano; What Is Subclinical Hypothyroidism?; 202 [www.healthline.com]
4. R.Tsuda, P03.01. Acupuncture's Effectiveness at Treating Subclinical Hypothyroid Disease via the
HPA/HPT Axis: A Multiple Case Series; Glob Adv Health Med. 2013 Nov; 2(Suppl): S135.
5. B. Arsovska, J. ZhuK. Kozovska , Case report - Acupuncture treatment in patient with high TSH
(thyroid- stimulating hormone); International Journal of Contemporary Applied
Researches Vol. 7, No. 4, 2020
6. B. Arsovska, J. Zhu, K. Kozovska, case report acupuncture treatment in female patients with
elevated anti-tpo levels; International Journal of Research Granthaalayah; 2020, 8(12), 1 4.
7. D. Malikov, Traditional Chinese Medicine Approach to Hypothyroidism; Int J Complement Alt
Med.2017, 5(1): 00142. DOI: 10.15406/ijcam.2017.05.00142
Corresponding author: Dr. Kristina Kozovska,
1 Faculty of Medical Sciences, University Goce Delchev, Shtip, Republic of Macedonia;
Medicine Faculty, St. Cyril and Methodius University of Skopje, Republic of Macedonia
Online publication Date: 03.07.2021
ResearchGate has not been able to resolve any citations for this publication.
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Slightly elevated level of TSH, normal T3/T4 levels and high Anti TPO level is a sign of subclinical hypothyroidism. More than 90% of the thyroid disease cases are caused by diseases that are autoimmune in nature. Hashimoto’s thyroiditis is a progressive and lifelong autoimmune disease. It starts subtly, usually long before the patient is diagnosed and develops slowly. In this research is presented a case of 38-year-old woman with elevated anti-TPO levels, without previous thyroid disorders. The patient has done 10 acupuncture treatments every two weeks in a period of 6 months. Before the treatment the anti-TPO level was 91.2 U/ml (<60.0 U/ml). After the treatment it was normalized to 54.8 U/ml. The TSH level before the treatment was also slightly elevated to the upper range – 4.39 pIU/ml (0.55-4.75 pIU/ml). After the treatment it was normalized to 2.08 pIU/ml. Acupuncture points used in the treatment are: RN4 (QuanYuan), RN6 (QiHai), DU20 (BaiHui), GB20 (FengChi), DU14 (DaZhui), LI4 (HeGu), DU4 (MingMen), BL15 (XinShu), ST9 (RenYing), BL20 (PiShu), BL23 (ShenShu), LR2 (TaiChong), SP9 (YinLingQuan), SP6 (SanYinJiao), ST36 (ZuSanLi), KI3 (TaiXi) and Ashi (trigger) points located on the neck (front and back). The acupuncture treatment is always most effective at the onset of the disease and gives good results in such pre-conditions. The acupuncture treatment is a great choice for prevention, as well as for more serious and advanced conditions
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A condition where there is elevated level of TSH and normal T4 and T3 levels is defined as subclinical hypothyroidism. Several studies showed that 4% to 8.5% of the individuals without known previous thyroid disease may actually have subclinical hypothyroidism as it was evidenced by the mildly elevated TSH level. TCM has a holistic view on the development of the diagnostic methods and treatmentstrategies for every patient individually. The purpose of the treatment is to help the individual's body ability to awaken to naturally heal itself.In this article is reported a case of a 49 year old woman diagnosed with hypothyroidism due to high levels of TSH. The diagnosis was made shortly before the acupuncture treatment began. The patient wasn't taking any additional medication therapy. 18 acupuncture treatments were made starting from 07.07.2018 to 20.03.2020. Before the treatment the TSH level was increased above the normal rate (5.31 mUI/ml) and after the treatment the TSH level was normalized (3.39 mUI/ml). Acupuncture is an effective treatment for patients with hypothyroidism due to high level of TSH. The treatment can effectively regulate the energy in the body and restore the hormonal balance and the balance of the endocrine system.
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Focus Area: Integrative Approaches to Care Purpose: Subclinical hypothyroid disease (SHypo) is defined as having serum thyroid-stimulating hormone (TSH) concentration above the normal reference range while serum free thyroxine (FT4) and free triiodothyronine (FT3) are within reference range. It is estimated that 4% to 10% of the general population has subclinical hypothyroidism, increasing to 20% in women over 60 years of age. The current treatment recommendation for SHypo with TSH levels between 3 MIU/L and 5 mIU/L is to monitor levels every 6 to 12 months. Studies have shown that levothyroxine is not effective for this TSH group. Based on Hans Selye's general adaption theory (GAS), it is known that acute and chronic stress can affect thyroid function via the hypothalamus-pituitary-adrenal (HPA) and the hypothalamus-pituitary-thyroid (HPT) axes. Acupuncture can reduce the body's stress response and therefore should improve thyroid function. This research was conducted to determine if acupuncture is a viable treatment option for SHypo. Methods: Two cases were studied for replication. The female patients, aged 34 and 44 years, received 12 Japanese Meridian acupuncture constitutional treatments and moxibustion once per week. Serum TSH, FT4, FT3, salivary cortisol, Perceived Stress Scale–10 (PSS-10) were measured at pretreatment, mid-treatment, and posttreatment. Number of hypothyroid symptoms present (Zulewski index) were assessed prior to each treatment. All measurements were analyzed for changes over time and cross-case comparison. Results: Both patients had decreases in TSH and number of hypothyroid symptoms present and increases in total cortisol load and morning diurnal cortisol rhythm. Both patients reported improvements in bowel movements and menstruation. Conclusion: From this study, it can be theorized that acupuncture is a viable treatment option for SHypo; however, more rigorous larger-scale research studies need to be conducted to validate and extend these findings.
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Subclinical hypothyroidism (SCH), also called mild thyroid failure, is diagnosed when peripheral thyroid hormone levels are within normal reference laboratory range but serum thyroid-stimulating hormone (TSH) levels are mildly elevated. This condition occurs in 3% to 8% of the general population. It is more common in women than men, and its prevalence increases with age. Of patients with SCH, 80% have a serum TSH of less than 10 mIU/L. The most important implication of SCH is high likelihood of progression to clinical hypothyroidism. The possibility that it is a cardiovascular risk factor has been a subject of debate. Large-scale randomized studies are needed for evidence-based recommendations regarding screening for mild thyroid failure and levothyroxine therapy for this condition. Currently, the practical approach is routine levothyroxine therapy for persons with a persistent serum TSH of more than 10.0 mIU/L and individualized therapy for those with a TSH of less than 10.0 mIU/L.
Deciding When to Treat
  • V Adlin
  • Subclinical Hypothyroidism
V. Adlin, Subclinical Hypothyroidism: Deciding When to Treat; Am Fam Physician. 1998 Feb 15; 57(4):776-780.