Efficacy of Xiaoyao-san preparations in treating Hashimoto’s thyroiditis: a meta-analysis and systematic review
ObjectiveTo assess Xiaoyao-san (XYS) preparations’ effectiveness in treating Hashimoto’s thyroiditis.MethodsEight databases were searched for randomized controlled trials (RCTs) comparing XYS preparations to a low-iodine diet (LID), selenium yeast (SY), levothyroxine (LT4), or Ophiocordyceps sinensi...
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Frontiers Media S.A.
2025-06-01
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| author | Chengna Wang Chengna Wang Wenxin Ma Lingling Qin Lingling Qin Lili Wu Tonghua Liu |
| author_facet | Chengna Wang Chengna Wang Wenxin Ma Lingling Qin Lingling Qin Lili Wu Tonghua Liu |
| author_sort | Chengna Wang |
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| description | ObjectiveTo assess Xiaoyao-san (XYS) preparations’ effectiveness in treating Hashimoto’s thyroiditis.MethodsEight databases were searched for randomized controlled trials (RCTs) comparing XYS preparations to a low-iodine diet (LID), selenium yeast (SY), levothyroxine (LT4), or Ophiocordyceps sinensis (OS) for HT treatment. The datasets from inception to September 2024. Two reviewers independently evaluated literature and research biases. Meta-analysis was done with Revman 5.4. The GRADE technique assessed evidence reliability. Robustness was assessed using sensitivity and trial sequential analysis (TSA).ResultsThis study analyzed seven randomized controlled trials involving 612 patients. Meta-analysis demonstrated that XYS preparations significantly reduced TPOAb levels [SMD = −0.74, 95% CI (−1.02, −0.46), p < 0.00001]. Combining LT4 with XYS preparations resulted in greater TPOAb reduction compared to LT4 alone [SMD = −0.77, 95% CI (−1.06, −0.47), p < 0.00001] and was more effective in lowering TgAb levels [SMD = −0.66, 95% CI (−1.05, −0.26), p = 0.001]. XYSJW outperformed OS in reducing TgAb [SMD = −0.35, 95% CI (−0.58, −0.10), p = 0.005]. Four XYS preparations (XY, HHXY, GQXY, and DZXY) increased FT3 and FT4 levels [SMD = 0.13, 95% CI (0.01, 0.61), p = 0.04; SMD = 0.58, 95% CI (0.12, 1.04), p = 0.01] and decreased TSH [SMD = −0.76, 95% CI (−0.98, −0.54), p < 0.00001]. Subgroup analysis indicated XY significantly improved FT3 and FT4 levels, but XYS preparations combined with LT4 did not enhance FT3/FT4 restoration. XYSJW also did not reduce TSH more effectively than OS. Evidence quality was low or very low. TSA confirmed the pooled effect estimates, with cumulative z-curves for TPOAb, TgAb, and TSH surpassing the benefit threshold.ConclusionCombination therapy with XYS preparations and LT4 may reduce TPOAb, TgAb, and TSH levels in HT patients. XY combined with LID or SY therapy is more effective at restoring FT3 and FT4 levels. While XYSJW outperforms OS preparations in lowering TgAb levels, it may not surpass OS in restoring thyroid hormone levels. Most studies reviewed are of low quality. XYS preparations appear to modulate cytokines by targeting immune markers and reducing inflammation, but their safety profile remains unclear, requiring further robust evidence.Systematic Review Registrationclinicaltrials.gov, identifier CRD42023472233. |
| format | Article |
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| publishDate | 2025-06-01 |
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| spelling | doaj-art-2c7d3a373f5d49a58014a8d7be42b1e92025-08-20T03:46:33ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-06-011610.3389/fphar.2025.15285061528506Efficacy of Xiaoyao-san preparations in treating Hashimoto’s thyroiditis: a meta-analysis and systematic reviewChengna Wang0Chengna Wang1Wenxin Ma2Lingling Qin3Lingling Qin4Lili Wu5Tonghua Liu6The Second Clinical Medical College of Beijing University of Chinese Medicine, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, ChinaKey Laboratory of Health Cultivation of Traditional Chinese Medicine, the Ministry of Education, Beijing University of Chinese Medicine, Beijing, ChinaCentre for Evidence-Based Chinese Medicine, School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, ChinaKey Laboratory of Health Cultivation of Traditional Chinese Medicine, the Ministry of Education, Beijing University of Chinese Medicine, Beijing, ChinaDepartment of Technology, Beijing University of Chinese Medicine, Beijing, ChinaKey Laboratory of Health Cultivation of Traditional Chinese Medicine, the Ministry of Education, Beijing University of Chinese Medicine, Beijing, ChinaKey Laboratory of Health Cultivation of Traditional Chinese Medicine, the Ministry of Education, Beijing University of Chinese Medicine, Beijing, ChinaObjectiveTo assess Xiaoyao-san (XYS) preparations’ effectiveness in treating Hashimoto’s thyroiditis.MethodsEight databases were searched for randomized controlled trials (RCTs) comparing XYS preparations to a low-iodine diet (LID), selenium yeast (SY), levothyroxine (LT4), or Ophiocordyceps sinensis (OS) for HT treatment. The datasets from inception to September 2024. Two reviewers independently evaluated literature and research biases. Meta-analysis was done with Revman 5.4. The GRADE technique assessed evidence reliability. Robustness was assessed using sensitivity and trial sequential analysis (TSA).ResultsThis study analyzed seven randomized controlled trials involving 612 patients. Meta-analysis demonstrated that XYS preparations significantly reduced TPOAb levels [SMD = −0.74, 95% CI (−1.02, −0.46), p < 0.00001]. Combining LT4 with XYS preparations resulted in greater TPOAb reduction compared to LT4 alone [SMD = −0.77, 95% CI (−1.06, −0.47), p < 0.00001] and was more effective in lowering TgAb levels [SMD = −0.66, 95% CI (−1.05, −0.26), p = 0.001]. XYSJW outperformed OS in reducing TgAb [SMD = −0.35, 95% CI (−0.58, −0.10), p = 0.005]. Four XYS preparations (XY, HHXY, GQXY, and DZXY) increased FT3 and FT4 levels [SMD = 0.13, 95% CI (0.01, 0.61), p = 0.04; SMD = 0.58, 95% CI (0.12, 1.04), p = 0.01] and decreased TSH [SMD = −0.76, 95% CI (−0.98, −0.54), p < 0.00001]. Subgroup analysis indicated XY significantly improved FT3 and FT4 levels, but XYS preparations combined with LT4 did not enhance FT3/FT4 restoration. XYSJW also did not reduce TSH more effectively than OS. Evidence quality was low or very low. TSA confirmed the pooled effect estimates, with cumulative z-curves for TPOAb, TgAb, and TSH surpassing the benefit threshold.ConclusionCombination therapy with XYS preparations and LT4 may reduce TPOAb, TgAb, and TSH levels in HT patients. XY combined with LID or SY therapy is more effective at restoring FT3 and FT4 levels. While XYSJW outperforms OS preparations in lowering TgAb levels, it may not surpass OS in restoring thyroid hormone levels. Most studies reviewed are of low quality. XYS preparations appear to modulate cytokines by targeting immune markers and reducing inflammation, but their safety profile remains unclear, requiring further robust evidence.Systematic Review Registrationclinicaltrials.gov, identifier CRD42023472233.https://www.frontiersin.org/articles/10.3389/fphar.2025.1528506/fullHashimoto’s thyroiditisXiaoyao-sanrandomized controlled trialsystematic reviewmeta-analysis |
| spellingShingle | Chengna Wang Chengna Wang Wenxin Ma Lingling Qin Lingling Qin Lili Wu Tonghua Liu Efficacy of Xiaoyao-san preparations in treating Hashimoto’s thyroiditis: a meta-analysis and systematic review Frontiers in Pharmacology Hashimoto’s thyroiditis Xiaoyao-san randomized controlled trial systematic review meta-analysis |
| title | Efficacy of Xiaoyao-san preparations in treating Hashimoto’s thyroiditis: a meta-analysis and systematic review |
| title_full | Efficacy of Xiaoyao-san preparations in treating Hashimoto’s thyroiditis: a meta-analysis and systematic review |
| title_fullStr | Efficacy of Xiaoyao-san preparations in treating Hashimoto’s thyroiditis: a meta-analysis and systematic review |
| title_full_unstemmed | Efficacy of Xiaoyao-san preparations in treating Hashimoto’s thyroiditis: a meta-analysis and systematic review |
| title_short | Efficacy of Xiaoyao-san preparations in treating Hashimoto’s thyroiditis: a meta-analysis and systematic review |
| title_sort | efficacy of xiaoyao san preparations in treating hashimoto s thyroiditis a meta analysis and systematic review |
| topic | Hashimoto’s thyroiditis Xiaoyao-san randomized controlled trial systematic review meta-analysis |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2025.1528506/full |
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