Article type
Abstract
"Objective: To assess Xiao-yao San (XYS) preparations' effectiveness in treating Hashimoto's thyroiditis.
Methods: Randomized controlled trials of XYS preparations with low-iodine diets, selenium yeast, or levothyroxine for HT treatment were found in eight databases. The database was searched since launch until September 2023. Two reviewers separately examined the literature for relevant information and study bias. Meta-analysis using Revman 5.4. The GRADE system assessed the accuracy of the evidence. Sensitivity and test sequence analysis (TSA) was used to evaluate the robustness of the evidence.
Results: Ultimately, a total of five randomized controlled trials (RCTs) were included in the analysis, involving a cohort of 340 individuals with HT. A meta-analysis demonstrated that XYS preparations effectively reduced levels of thyroid peroxidase antibody (TPOAb) (SMD, -0.74; 95%Cl -1.02, -0.46; p < 0.00001). Additionally, the combination of levothyroxine or selenium-yeast tablets was more effective in reducing TPOAb levels compared to XYS preparations alone (SMD, -0.66; 95%Cl -1.05, -0.26; p = 0.001). XYS preparations were also superior in lowering thyroglobulin antibodies (TgAb) (SMD, -0.66; 95%Cl -1.05, -0.26; p = 0.001), particularly when combined with levothyroxine or selenium yeast tablets rather than a low-iodine diet. The XYS preparations demonstrated superiority in increasing FT3 (SMD, 0.58; 95%Cl 0.12, 1.04; p = 0.01), elevating FT4 (SMD, -0.76; 95%Cl -0.98, -0.54; p < 0.00001), and decreasing TSH (SMD, -0.76; 95%Cl -0.98, -0.54; p < 0.00001). Additionally, XYS preparations, when combined with a low-iodine diet or selenium-yeast tablets, showed even greater efficacy in restoring serum FT3 and FT4 levels. No evidence was high-quality. TSA showed that TPOAb, TgAb, and TSH cumulative zcurves exceeded benefit criteria, confirming the meta-analysis' combined effect estimates.
Conclusion: XYS formulations, along with other treatments, may reduce thyroid autoantibodies and restore thyroid function in HT patients. The studies featured were low-quality. Our investigation also showed that XYS preparations can regulate cytokines by affecting immunological variables and reducing inflammation. However, XYS preparations' safety is yet unknown, and more strong data is needed to prove their efficacy and safety and to understand their mode of action.
Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023472233."
Methods: Randomized controlled trials of XYS preparations with low-iodine diets, selenium yeast, or levothyroxine for HT treatment were found in eight databases. The database was searched since launch until September 2023. Two reviewers separately examined the literature for relevant information and study bias. Meta-analysis using Revman 5.4. The GRADE system assessed the accuracy of the evidence. Sensitivity and test sequence analysis (TSA) was used to evaluate the robustness of the evidence.
Results: Ultimately, a total of five randomized controlled trials (RCTs) were included in the analysis, involving a cohort of 340 individuals with HT. A meta-analysis demonstrated that XYS preparations effectively reduced levels of thyroid peroxidase antibody (TPOAb) (SMD, -0.74; 95%Cl -1.02, -0.46; p < 0.00001). Additionally, the combination of levothyroxine or selenium-yeast tablets was more effective in reducing TPOAb levels compared to XYS preparations alone (SMD, -0.66; 95%Cl -1.05, -0.26; p = 0.001). XYS preparations were also superior in lowering thyroglobulin antibodies (TgAb) (SMD, -0.66; 95%Cl -1.05, -0.26; p = 0.001), particularly when combined with levothyroxine or selenium yeast tablets rather than a low-iodine diet. The XYS preparations demonstrated superiority in increasing FT3 (SMD, 0.58; 95%Cl 0.12, 1.04; p = 0.01), elevating FT4 (SMD, -0.76; 95%Cl -0.98, -0.54; p < 0.00001), and decreasing TSH (SMD, -0.76; 95%Cl -0.98, -0.54; p < 0.00001). Additionally, XYS preparations, when combined with a low-iodine diet or selenium-yeast tablets, showed even greater efficacy in restoring serum FT3 and FT4 levels. No evidence was high-quality. TSA showed that TPOAb, TgAb, and TSH cumulative zcurves exceeded benefit criteria, confirming the meta-analysis' combined effect estimates.
Conclusion: XYS formulations, along with other treatments, may reduce thyroid autoantibodies and restore thyroid function in HT patients. The studies featured were low-quality. Our investigation also showed that XYS preparations can regulate cytokines by affecting immunological variables and reducing inflammation. However, XYS preparations' safety is yet unknown, and more strong data is needed to prove their efficacy and safety and to understand their mode of action.
Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023472233."