SynthesisFrontiers in endocrinology2026
Efficacy of methimazole combined with traditional Chinese medicine in the treatment of Graves' disease: a systematic review and network meta-analysis.
Synthesis in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Traditional Chinese Medicine (TCM) Combined with Methimazole (MMI) versus MMI Alone for Thyroid Function and Autoantibodies in Graves' Disease(GD). Methods: A systematic literature search was performed in PubMed, Cochrane Library, Web of Science, EMBASE, CNKI, VIP, CBM, and Wanfang databases up to June 2025 for RCTs comparing TCM plus MMI versus MMI alone. Study risk of bias was evaluated using the Cochrane tool. We assessed transitivity to ensure intervention comparability, verified consistency via node-splitting analysis, and planned sensitivity analysis according to risk-of-bias classification. A network meta-analysis was conducted in Stata 15.1 using a random-effects model. Results are reported as mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI), and treatment efficacy was ranked using SUCRA values. Results: A network meta-analysis of 15 RCTs involving 1,317 GD patients and 14 TCM plus MMI regimens showed potential advantages over MMI alone in improving thyroid function indices and reducing selected autoantibodies, particularly TRAb and TPOAb. Adverse events were summarized descriptively because AE reporting was incomplete and heterogeneous across the included RCTs. Regarding SUCRA rankings, the Modified Huagan Decoction (MHD) + MMI ranked first for reducing FT3 (SUCRA = 93.4%), the Modified Xiaoyao Powder (MXYP) + MMI ranked first for reducing FT4 (SUCRA = 97.3%), and the Xiaoyao Powder (XYP) + MMI ranked first for regulating TSH (SUCRA = 96.3%). For decreasing TRAb, the MHD + MMI regimen ranked first (SUCRA = 88.2%), while for lowering TPOAb, the Huotan Jiangni Formula (HJF) + MMI showed the highest SUCRA ranking (SUCRA = 100%). Conclusion: TCM combined with MMI may have beneficial effects on thyroid function and selected autoantibody levels, particularly TRAb and TPOAb, in GD patients versus MMI alone. Among the evaluated regimens, MHD + MMI, MXYP + MMI, XYP + MMI, and HJF + MMI showed high SUCRA rankings for specific outcomes, including FT3, FT4, TSH, TRAb, and TPOAb. These findings suggest that TCM plus MMI may be a promising short-term adjunctive strategy for initial GD treatment, although safety evidence remains limited by incomplete and inconsistent AE reporting. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD420251151307.
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