Efficacy and Feasibility of Acupuncture-Related Treatments for Anxiety and Depression in Hashimoto Thyroiditis: A Review

Journal of Complementary Therapies in Health ISSN 2975-9323 |eISSN 2975-9552 Journal of Complementary Therapies in Health 2026:4(1). doi:10.5281/zenodo.17956663 institutoptc.com/journal-complementary-therapies Review Efficacy and Feasibility of Acupuncture-Related Treatments for Anxiety and Depression in Hashimoto Thyroiditis: A Review. Munkhzul Sugar Tomas1*, Cíntia Nunes2, Gabriela Ramos Moreira3, Rafaela Oliveira Silva4, Sebastiana Santos2 and Raquel Montenegro3. 1 ABS – Health Level, Atlântico Business School, Vila Nova de Gaia, Porto, Portugal; 2 IPN – Portuguese Institute of Naturology, Porto, Portugal; 3 Independent researcher; 4 Rafaela Silva Terapeuta Manual, Vila Nova de Famalicão, Portugal. * Correspondence: [email protected] Abstract Objective: To review the efficacy of acupuncture-related therapies in ameliorating mood disturbances, specifically depression and anxiety, associated with Hashimoto's Thyroiditis (HT). Methods: A comprehensive electronic search was conducted across databases including PubMed, Cochrane Library, and Wan Fang to identify randomised controlled trials (RCTs) investigating acupuncture-related therapy for depression and anxiety in HT patients. The search timeframe extended from the database inception until September 2025. Results: A total of 8 papers met the inclusion criteria. The overall findings suggest that acupuncturerelated therapy may contribute to the improvement of patients' mental disorder symptoms, such such as depression and anxiety. This improvement appears to be dependent on the specific technique and acupuncture meridians and points employed. However, only one study reported significant changes in Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A) and Hospital Anxiety and Depression Scale Depression subscale (HADS-D) scores, focusing specifically on HT patients presenting with a Traditional Chinese Medicine (TCM) pattern of liver-qi stagnation. Other included studies reported no statistically significant changes in overall HADS scores. From the TCM perspective, liver-qi stagnation is posited to impair spleen and kidney function, contributing to mood disorders and depression. Regarding therapeutic efficiency, the aforementioned study documented statistically significant increases in the Role Emotional (RE) and Mental Health (MH) components of the SF-36 quality of life assessment (P<0.01, P<0.001). Furthermore, both TCM symptom scores and HADS-A scores were significantly reduced following treatment in both the treatment and control groups (P<0.001, P<0.01). Conversely, in the control group, these scores were observed to increase after the intervention (P<0.05, P<0.01, P<0.001). Crucially, all reviewed papers, with a single exception, indicated a superior improvement in serum Thyroid Peroxidase Antibody (TPOAb) levels in the acupuncture-related therapy group compared to the Western medicine administration group. Conclusion: Acupuncture-related therapy demonstrates potential benefit in mitigating mood disorder symptoms, such as depression and anxiety, in patients with Hashimoto's thyroiditis. Nevertheless, the robustness of these conclusions requires further validation, constrained by the current limitations in the availability of high quality, large-scale clinical studies specifically addressing depression and anxiety in HT patients. Keywords: Hashimoto Thyroiditis; Acupuncture; Depression; Anxiety; Mood; Thyroid Antibodies. Citation: Tomas M.S., Nunes C., Moreira G.R., Silva R.O., Santos S., Montenegro R. Efficacy and Feasibility of Acupuncture-Related Treatments for Anxiety and Depression in Hashimoto Thyroiditis: A Review. Journal of Complementary Therapies in Health. 2026;4(1) 10.5281/zenodo.17956663 Academic Editor: Jorge Rodrigues Received: 23 November 2025 Reviewed: 1 December 2025 Revised: 9 December 2025 Accepted: 10 December 2025 Published: 16 December 2025 Publisher’s Note: IPTC stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: ©2026 by the authors. Submitted for open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Journal of Complementary Therapies in Health 2026: 4(1). 2 of 9 Tomas M.S., Nunes C., Moreira G.R., Silva R.O., Santos S., Montenegro R. Efficacy and Feasibility of Acupuncture-Related Treatments for Anxiety and Depression in Hashimoto Thyroiditis: A Review. doi:10.5281/zenodo.17956663 1. Background HT represents the most prevalent autoimmune thyroid disease, with a global prevalence of 7.5% and a notably increasing rate of approximately 7.8% in Europe 1. The condition exhibits a marked sex disparity, with a higher prevalence in women (17.5%) compared to men (6.0%)2. First described by Japanese scientist Hakaru Hashimoto in 1912 3, HT is also termed 4. It is characterised by the immune-mediated destruction of the thyroid gland, leading to insufficient production of thyroid hormones and subsequent hypothyroidism. Common clinical manifestations include cold intolerance, dry skin, periorbital puffiness, constipation, weight gain, bradycardia, potential goitre development, musculoskeletal pain, and fatigue. Critically, patients frequently experience concomitant psychiatric comorbidities, including mood swings, cognitive impairment ("brain fog"), depression, and anxiety 4-6. An established association exists between Autoimmune Thyroiditis and mood disorders. Meta-analytical findings indicate that patients with HT exhibit significantly higher scores on standardised depression instruments, with a pooled odds ratio (OR) of 3.56 (95% CI, 2.14-5.94; I2 = 92.1%). For anxiety disorders, the pooled OR was 2.32 (95% CI, 1.40-3.85; I2 = 89.8%) 7. 2. Pathogenesis of Hashimoto Thyroiditis-Associated Anxiety and Depression in Western Medicine In the initial stages of Hashimoto's disease, damage to the thyroid gland can result in the transient release of thyroid hormones into the bloodstream, potentially causing transient hyperthyroidism. This fluctuation can acutely manifest as symptoms such as agitation, anxiety, and even psychosis. Subsequent depletion of thyroid hormone reserves often results in a state of functional hypothyroidism, which is frequently correlated with depressive symptoms, including apathy, low mood, fatigue, and cognitive dysfunction 8. Given the critical role of thyroid hormones in the central nervous system (CNS), particularly in the production of neurotrophic factors and the regulation of mood 9, the link between HT and psychiatric disorders is often primarily attributed to HT-induced hypothyroidism⁶. Studies have consistently confirmed the strong association between hypothyroidism and depression 1. Furthermore, several investigations have established a correlation between mood disturbances and the presence of thyroid peroxidase (TPO) antibodies 10. Elevated levels of TPO antibodies are associated with depression, general distress, obsessive-compulsive symptoms, and anxiety 11. Notably, the presence of TPO antibodies constitutes an early indicator of an autoimmune attack on the thyroid, sometimes preceding discernible changes in Thyroid-Stimulating Hormone (TSH) levels 7. Research by Churilov et al. 12 on Hashimoto's encephalopathy demonstrated that autoantibodies can exert significant effects on the nervous system. This finding supports the hypothesis of an independent influence of thyroid antibodies on anxiety and depression 13. One study reported that HT patients with euthyroid TSH levels exhibited significant scores on the Beck Anxiety Inventory and Beck Depression Inventory in 81% and 89% of cases, respectively 1. Patti et al. 14 reviewed the link between anti-thyroid antibodies and quality of life, including mental health. They found a statistically significant correlation (P < 0.05) between symptom distress and antibody levels in three studies, with one study specifically reporting a significant association (P < 0.05) between antibodies and mental health. An additional factor implicated in mental disorders among HT patients is selenium deficiency. Like iodine deficiency, selenium deficiency may contribute to the development of HT, particularly in individuals residing in areas with low soil selenium content 15. HT patients with co-morbid depression should be reasonably assessed for selenium status. Beyond its role as an essential trace element required for thyroid hormone synthesis and its antioxidant properties 16, selenium possesses neuroprotective, antioxidant, and antiinflammatory activities that safeguard the CNS and regulate mood. Journal of Complementary Therapies in Health 2026: 4(1). 3 of 9 Tomas M.S., Nunes C., Moreira G.R., Silva R.O., Santos S., Montenegro R. Efficacy and Feasibility of Acupuncture-Related Treatments for Anxiety and Depression in Hashimoto Thyroiditis: A Review. doi:10.5281/zenodo.17956663 Figure 1. Hashimoto Thyroiditis-Associated Anxiety and Depression Pathogenesis. 3. Pathogenesis and TCM Patterns of Hashimoto Thyroiditis-Related Depression and Anxiety From the perspective of TCM, Hashimoto's thyroiditis is classified under the category of “gall disease”. Its pathogenesis is understood as a complex interplay of constitutional factors, emotional disorders, and improper diet, leading to the accumulation of vital energy (Qi) stagnation, phlegm coagulation, and blood stasis in the anterior laryngeal region. The characteristic manifestation is a swelling or mass ("gall swelling") in front of the neck 17. HT primarily affects the Liver, Spleen, and Kidney organ systems. The core pathogenesis is described as Spleen and Kidney Yang Deficiency alongside Liver and Spleen disorders. The disease essence is characterised as a deficiency in origin (ben xu) and an excess in manifestation (biao shi), often presenting as a mixed deficiency and excess pattern 17,18. HT patients frequently exhibit a chronic state of Yang Qi and Blood deficiency in the Spleen and Kidneys. Autoimmune hypothyroidism is further classified into four main TCM patterns 19: 1. Spleen and Kidney Qi Deficiency: This pattern is typically observed in the early stages of an underactive thyroid (Hashimoto’s thyroiditis). Emotional disturbances, such as anger or depression, can cause Liver Qi stagnation, impeding its smooth flow, which subsequently affects the Spleen and Kidney function. This dysfunction can lead to the generation of phlegm and blood stasis, resulting in mood disorders, depression, and a sensation of neck fullness. Associated symptoms include fatigue, cold sensitivity, poor appetite, constipation, weight gain, weak bladder function, and menstrual irregularities. Physical examination reveals a pale and scalloped tongue and a weak, thready, and deep pulse 20. The treatment principle is to fortify and replenish Spleen and Kidney Qi and dissolve phlegm. 2. Heart and Kidney Yang Deficiency: This pattern also includes depression along with severe cold intolerance, periorbital and facial puffiness, weight gain, dry skin and hair, lack of sweating, poor appetite, frequent urination, constipation, a hoarse voice, and low basal body temperature. The tongue is pale, swollen, and scalloped. The pulse is weak, slow, or imperceptible. The treatment principle is to warm and supplement Kidney, Spleen, and Heart Yang 20. 3. Shaoyin Pattern-Yang and Qi Deficiency: This pattern is particularly associated with psychiatric disorders, including anxiety and depression. Common symptoms are Anxiety and Depression in HT Elevated anti-thyroid bodies Fluctations of thyroid hormones Low Selenium level Chronic inflammation Journal of Complementary Therapies in Health 2026: 4(1). 4 of 9 Tomas M.S., Nunes C., Moreira G.R., Silva R.O., Santos S., Montenegro R. Efficacy and Feasibility of Acupuncture-Related Treatments for Anxiety and Depression in Hashimoto Thyroiditis: A Review. doi:10.5281/zenodo.17956663 profound fatigue, coldness in the extremities, insomnia, and night sweats. It is a deficiency syndrome involving both Yang and Qi deficiency. 4. Deficiency and Loss of Kidney Essence The primary organs involved are the Spleen and Kidney, with the Heart becoming affected in advanced stages 19. Figure 2. Pathogenesis of Hashimoto Thyroiditis-Related Depression and Anxiety according to TCM. 4. TCM Pathophysiology and Treatment Modalities for Hashimoto Thyroiditis Patients with Depression and Anxiety Currently, there is no definitive, specific cure for HT in Western medicine. The standard treatment is oral levothyroxine sodium tablets. The therapeutic effects of supplements like selenium, as well as interventions such as surgery and low-intensity laser methods, remain unconfirmed 21. Furthermore, long-term use of levothyroxine may induce complications related to the cardiovascular system and bone metabolism 22. Extensive research by Chinese scholars supports the efficacy of Traditional Chinese Medicine in modulating the endocrine system, regulating body immunity, promoting the clearance of autoantibodies, and stabilising pituitary function. The therapeutic effect of TCM in the management of thyroid diseases is considered particularly noteworthy 17. This is likely attributable to TCM’s principle of individualised treatment, wherein practitioners formulate a specific protocol based on the patient's unique symptomatology and underlying imbalances. The TCM management of autoimmune hypothyroid disease incorporates long-term acupuncture-related therapies, such as electroacupuncture, interlayer moxibustion, Peripheral Acupuncture, and acupuncture combined with tuina 23, in addition to herbal medicine. Acupuncture is utilised in HT treatment to regulate energy levels, restore hormonal balance, smooth emotions, and manage sleep, emotional, and menstrual issues 22,24. Stimulation of the nervous system via needling induces specific biochemical changes within the body, thereby influencing the body's homeostatic mechanisms and promoting physical and emotional well-being 24. Given that TCM identifies the fundamental cause of Hashimoto's hypothyroidism as Kidney Yin and Yang deficiency, specific acupuncture points are selected to strengthen Liver and Kidney Yin, clear internal heat, and restore Kidney Yang. Anger, Fear, Excessive worry, Stress Liver Qi Stagnation Spleen and Kidney Qi Deficiency Phlegm and Blood Stasis Anxiety and Depression Mood disorders Journal of Complementary Therapies in Health 2026: 4(1). 5 of 9 Tomas M.S., Nunes C., Moreira G.R., Silva R.O., Santos S., Montenegro R. Efficacy and Feasibility of Acupuncture-Related Treatments for Anxiety and Depression in Hashimoto Thyroiditis: A Review. doi:10.5281/zenodo.17956663 5. Methods A computerised search was executed across Wan Fang, PubMed, Cochrane Library, and other relevant databases to identify RCTs investigating acupuncture-related therapy for depression and anxiety in the context of Hashimoto's thyroiditis. The literature review was independently performed by two researchers and included articles published in English, Chinese, and Russian. The search encompassed the period from the database's inception until September 1, 2025. The primary efficiency indicators sought in the RCT results were the HADS-A and HADS-D scores, reflecting the focus of the paper on the improvement of depression and anxiety symptoms in HT patients. Given the established link between mood disorder and the presence of TPO antibodies, papers reporting outcomes for TPOab and TGab levels following acupuncture-related therapy for anxiety and depression in HT patients were also included for review. 6. Acupuncture-Related Therapy Results in Hashimoto Thyroiditis Anxiety and Depression A study 25 investigating the feasibility of Hand Yangming Meridian Penetrating Acupuncture in HT-related hypothyroidism randomised 58 subjects (ratio 1:1). After a 16week treatment period, no statistically significant difference was observed in the change of TPOab levels between the two groups. However, the TGab level in the acupuncture group was significantly lower than in the waiting list control group (difference: -141.97 [95% CI: -222.4 to -61.5], P = 0.011). There was no statistical difference noted in the HADSD scores between the groups. The acupuncture protocol involved points such as Sanjian (LI3), Hegu (LI4), Quchi (LI11), Binao (LI14), Jianyu (LI15), Renying (ST9), and Zusanli (ST36). The technique employed was penetration needling with manipulation (lifting, inserting, twisting, turning) to achieve deqi. The researchers concluded that Hand Yangming Meridian Penetrating Acupuncture may reduce TGab levels and improve symptoms. TCM practitioners, such as Yu et al. 26 propose that not only Hand Yangming but also Foot Yangming meridians are effective in HT treatment due to their circulation paths near the neck. Thirty HT patients were treated with acupuncture points including Quchi, Jianyu, Hegu, Shuitu, Zusanli, Binao, Renying, Shuitu, and Zhongwan. The 12-week acupuncture course was combined with levothyroxine (Euthyrox) intake. Post-treatment analysis showed that the Visual Analog Scale (VAS) score for neck discomfort, TCM syndrome score, and TPOAb level were all significantly reduced compared to pre-treatment values. In another study 27, acupoint application was reported to reduce serum levels of TgAb and TPOAb in 150 HT patients with liver-qi stagnation, concurrently alleviating thyroid enlargement, improving TCM symptoms such as anxiety, and enhancing quality of life. The patients were randomly divided into an acupoint application group and a placebo control group, treated over 4 weeks. Acupoints used in both groups included Shenque (CV 8), bilateral Yongquan (KI 1), Yeshi, and Ashi point. Post-treatment, the acupoint application group showed reduced serum levels of TgAb and TPOAb (P<0.05). The Role Emotional (RE) and Mental Health (MH) components of the SF-36 were significantly increased (P<0.01, P<0.001). Both TCM symptom scores and HADS-A scores were lowered compared to pre-treatment in both groups (P<0.001, P<0.01). Conversely, these scores increased after treatment in the control group (P<0.05, P<0.01, P<0.001). A systematic review and meta-analysis 28 comparing the effectiveness of acupuncture versus levothyroxine sodium tablets in HT included 14 RCTs (1020 participants). The meta-analysis results indicated that acupuncture significantly regulated TPOAb content (mean difference [MD] = -63.18, 95% CI = -91.73 to -34.62, P < 0.00001) and TGAb content (MD = -68.56, 95% CI = -101.55 to -35.57, P < 0.00001). However, for the HADS scores, reported in 4 studies, there was no significant reduction for either the HADS-A score (MD = 0.24, 95% CI = -0.93 to 1.41, P = 0.86) or the HADS-D score (MD = -0.81, 95% CI = -2.02 to 0.40, P = 0.25). Both analyses exhibited low heterogeneity (I2 = 0%, P = 0.69 and I2 = 0.25%, P = 0.19, respectively) 28. Journal of Complementary Therapies in Health 2026: 4(1). 6 of 9 Tomas M.S., Nunes C., Moreira G.R., Silva R.O., Santos S., Montenegro R. Efficacy and Feasibility of Acupuncture-Related Treatments for Anxiety and Depression in Hashimoto Thyroiditis: A Review. doi:10.5281/zenodo.17956663 A clinical trial by Qiao et al. 27 involving 62 HT patients (predominantly female; average age 46 years old) over 3 months combined acupuncture treatment with levothyroxine sodium tablets. The trial demonstrated no significant difference between the combined therapy and levothyroxine alone in reducing the HADS-A score (MD = 0.33, 95% CI = - 1.19 to 1.85, P = 0.86) or the HADS-D score (MD = -1.82, 95% CI = -3.92 to 0.28, P = 0.25), showing low heterogeneity (I2 = 0%, P = 0.69 and I2 = 25%, P = 0.19, respectively). A case study 24 reported the successful treatment of a 24-year-old woman diagnosed with HT and TCM diagnosis of Kidney and Spleen Qi Deficiency. Treatment, administered monthly over 3 years and 8 months, involved points: DU20 (BaiHui), GB20 (FengChi), DU14 (DaZhui), ST9 (RenYing), LI4 (HeGu), BL15 (XinShu), BL20 (PiShu), BL23 (ShenShu), DU4 (MingMen), RN6 (QiHai), RN4 (QuanYuan), SP9 (YinLingQuan), ST36 (ZuSanLi), SP6 (SanYinJiao), KI3 (TaiXi), and LR2 (TaiChong). The patient’s Eutirox dosage was gradually reduced until cessation, coinciding with the normalisation of her T4, TSH, and TPO levels. Concurrently, symptoms including fatigue, tiredness, and depression significantly improved. An additional review of Chinese literature described 8 studies where acupuncture and moxibustion demonstrated superiority over Western medicine in reducing TPOAb levels in HT treatment. High heterogeneity was observed (I2=94%, P<0.05), with a combined effect size of SMD = -2.18 (95% CI [-3.04, -1.32]) and a test statistic Z=4.96 (P<0.00001). Improvement in TCM syndrome scores by acupuncture was reported in 2 studies, with high heterogeneity (I2=91%) and a combined effect size of SMD = -1.30 (95% CI [-2.57, - 0.03]), Z=2.01 (P=0.04). Four of these studies incorporated a treatment protocol of bridge arch massage combined with acupuncture 29,30. Luzina et al. 31 reported that following corporal acupuncture and ear acupuncture for HT in Russia, 20% of patients discontinued hormonal medication, and 77% were able to reduce their dosage by a third. Crucially, all patients reported a decrease in the level of anxiety and depression. Key acupoints utilised, often combined with moxibustion, included Guanyuan (CV4), Shenshu (BL23), Mingmen (GV4), and Qihai (CV6). 7. Discussion A total of 8 publications were selected for this systematic review from 33 initial papers identified regarding acupuncture-related therapy in HT. The synthesis of results suggests that acupuncture-related therapy may positively influence the amelioration of patients' mental disorder symptoms, particularly depression and anxiety. However, a critical finding is that only a single study documented significant changes in HADS-A and HADS-D scores. This specific study focused on HT patients exhibiting the TCM pattern of liver-qi stagnation. Other reviewed papers, in contrast, showed no significant changes in overall HADS scores. This highlights a potential link between the TCM pattern (liver Qi stagnation affecting spleen and kidney function) and the manifestation of mood disorders. The study showing positive HADS results also reported significant increases in the RE and MH components of the SF-36 (P<0.01, P<0.001), with simultaneous reductions in TCM symptom scores and HADS-A scores in both groups post-treatment, whereas the control group showed an increase in these scores (P<0.05, P<0.01, P<0.001) 27. Regarding objective biological indicators, all but one reviewed paper reported that the improvement in serum TPO-Ab levels was superior in the acupuncture-related therapy group compared to the Western medicine (levothyroxine sodium tablets) administration group. The common methods employed in the acupuncture-related treatment groups included acupuncture, massage, J-type needle knife, warm acupuncture, and moxibustion, utilising various techniques. The control groups primarily received administration of levothyroxine sodium tablets. The most frequently considered and utilised acupuncture points included: Sanjian (LI3), Hegu (LI4), Quchi (LI11), Binao (LI14), Jianyu (LI15), Renying (ST9), Zusanli (ST36), Journal of Complementary Therapies in Health 2026: 4(1). 7 of 9 Tomas M.S., Nunes C., Moreira G.R., Silva R.O., Santos S., Montenegro R. Efficacy and Feasibility of Acupuncture-Related Treatments for Anxiety and Depression in Hashimoto Thyroiditis: A Review. doi:10.5281/zenodo.17956663 Shuitu (ST10), Zhongwan (CV12), Shenque (CV 8), Yongquan (KI 1), BaiHui (DU20), FengChi (GB20), DaZhui (DU14), XinShu (BL15), PiShu (BL20), ShenShu (BL23), MingMen (DU4), QiHai (RN6), QuanYuan (RN4), YinLingQuan (SP9), SanYinJiao (SP6), TaiXi (KI3), and TaiChong (LR2). This study is subject to several limitations. A significant constraint is the scarcity of high-quality, large-sample-sized RCTs specifically focused on the anxiety and depression symptoms in HT patients. Furthermore, the included randomised controlled clinical trials often present methodological shortcomings such as small sample sizes, incomplete reporting (e.g., details on acupuncture protocols, duration, treatment course variability), and insufficient reporting of adverse reactions. These limitations pose a considerable challenge for researchers attempting to rigorously analyse the feasibility, efficacy, and safety of acupuncture-related treatments for alleviating mental disturbance symptoms in HT. 8. Conclusion Acupuncture-related therapy appears to be a beneficial adjunct in improving mood disorder symptoms, specifically depression and anxiety, in patients with Hashimoto's thyroiditis. There is evidence that acupuncture can contribute to lowering thyroid antibodies, which in turn may positively impact the mental disturbance symptoms and overall quality of life of HT patients. However, the final conclusions necessitate further rigorous validation due to the identified limitations in the availability of high-quality, large-scale clinical studies dedicated to depression and anxiety in the HT population. Author statement: Conceptualisation: M.S.T.; Investigation: M.S.T.; Writing, reviewing and editing: M.S.T., C.N., G.R.M., R.O.S., S.S., and R.M. All authors have read and agreed to the published version of the manuscript. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflict of Interest: The authors declare that there are no conflicts of interest. Institutional Review Board Statement: Not applicable. Informed Consent Statement: Not applicable. Data Availability Statement: The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author. References 1. Wang B, Huang J, Chen L. Association between depression and anxiety disorders with euthyroid Hashimoto's thyroiditis: A systematic review and meta-analysis. Compr Psychoneuroendocrinol. 2024;20:100279. doi: https://doi.org/10.1016/j.cpnec.2024.100279 2. Hu X, Chen Y, Shen Y, Tian R, Sheng Y, Que H. Global prevalence and epidemiological trends of Hashimoto's thyroiditis in adults: A systematic review and meta-analysis. Front Public Health. 2022;10:1020709. doi: https://doi.org/10.3389/fpubh.2022.1020709 3. Hashimoto H. Zur Kenntniss der lymphoatosen Veranderung der Schilddrüse (Struma lymphomatoa). Langenbecks archiv fur klinische chirurgie. 1912;97:219-48. 4. McDermott MT. Hypothyroidism. Ann Intern Med. 2020;173(1):ITC1-ITC16. doi: https://doi.org/10.7326/AITC202007070 Journal of Complementary Therapies in Health 2026: 4(1). 8 of 9 Tomas M.S., Nunes C., Moreira G.R., Silva R.O., Santos S., Montenegro R. Efficacy and Feasibility of Acupuncture-Related Treatments for Anxiety and Depression in Hashimoto Thyroiditis: A Review. doi:10.5281/zenodo.17956663 5. Gomez Saez JM. Chronic autoimmune thyroiditis and thyroid cancer. Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion. 2014;61(6):299-301. doi: https://doi.org/10.1016/j.endonu.2014.03.006 6. Danailova Y, Velikova T, Nikolaev G, Mitova Z, Shinkov A, Gagov H, et al. Nutritional Management of Thyroiditis of Hashimoto. International journal of molecular sciences. 2022;23(9). doi: https://doi.org/10.3390/ijms23095144 7. Siegmann EM, Muller HHO, Luecke C, Philipsen A, Kornhuber J, Gromer TW. Association of Depression and Anxiety Disorders With Autoimmune Thyroiditis: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2018;75(6):577-84. doi: https://doi.org/10.1001/jamapsychiatry.2018.0190 8. Hage MP, Azar ST. The Link between Thyroid Function and Depression. J Thyroid Res. 2012;2012:590648. doi: https://doi.org/10.1155/2012/590648 9. Beydoun MA, Beydoun HA, Kitner-Triolo MH, Kaufman JS, Evans MK, Zonderman AB. Thyroid hormones are associated with cognitive function: moderation by sex, race, and depressive symptoms. J Clin Endocrinol Metab. 2013;98(8):3470-81. doi: https://doi.org/10.1210/jc.2013-1813 10. Mussig K, Kunle A, Sauberlich AL, Weinert C, Ethofer T, Saur R, et al. Thyroid peroxidase antibody positivity is associated with symptomatic distress in patients with Hashimoto's thyroiditis. Brain Behav Immun. 2012;26(4):559-63. doi: https://doi.org/10.1016/j.bbi.2012.01.006 11. National Health Service. Symptoms: Overactive Thyroid (hyperthyroidism) nd. [updated September 2019. Available from: https://www.nhs.uk/conditions/overactivethyroid hyperthyroidism/symptoms/ 12. Churilov LP, Sobolevskaia PA, Stroev YI. Thyroid gland and brain: Enigma of Hashimoto's encephalopathy. Best Pract Res Clin Endocrinol Metab. 2019;33(6):101364. doi: https://doi.org/10.1016/j.beem.2019.101364 13. Engum A, Bjoro T, Mykletun A, Dahl AA. Thyroid autoimmunity, depression and anxiety; are there any connections? An epidemiological study of a large population. Journal of psychosomatic research. 2005;59(5):263-8. doi: https://doi.org/10.1016/j.jpsychores.2005.04.002 14. Patti M, Christian R, Palokas M. Association between anti-thyroid antibodies and quality of life in patients with Hashimoto thyroiditis: a systematic review and meta-analysis. JBI Evidence Synthesis. 2021;19(9). doi: https://doi.org/10.11124/JBIES-2000043 15. Sher L. Role of thyroid hormones in the effects of selenium on mood, behavior, and cognitive function. Med Hypotheses. 2001;57(4):480-3. doi: https://doi.org/10.1054/mehy.2001.1369 16. Huwiler VV, Maissen-Abgottspon S, Stanga Z, Muhlebach S, Trepp R, Bally L, et al. Selenium Supplementation in Patients with Hashimoto Thyroiditis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Thyroid. 2024;34(3):295-313. doi: https://doi.org/10.1089/thy.2023.0556 17. She K, Dai C. Analysis of TCM Diagnosis and Treatment of Thyroid Diseases Based on Data Mining. Journal of Physics: Conference Series. 2021;1852(4):042080. doi: https://doi.org/10.1088/1742-6596/1852/4/042080 18. 徐 潇. Research Progress in the Treatment of Hashimoto Thyroiditis by Traditional Chinese Medicine. Traditional Chinese Medicine. 2025;14(03):928-32. doi: https://doi.org/10.12677/tcm.2025.143138 19. Luzina C, Xin N, editors. Autoimmune thyroiditis-an ancient approach of traditional Chinese medicine to a modern disease 2014. 20. Arsovska B, Zhu J, K K. Case Report: Acupuncture Treatment for Hypothyroidism. Imperial Journal of Interdisciplinary Research. 2016;2:184-7. 21. Lou X, Huang Y, Qiu J, Sun J, Gu Q, Wang H, et al. Effect of Integrated Treatment with Traditional Chinese Medicine on Hashimoto’s Thyroiditis Patients. Journal of Clinical Pharmacy and Therapeutics. 2023;2023(1):5574095. doi: https://doi.org/10.1155/2023/5574095 22. S. A. The Early Diagnosis and Treatment of Hypothyroidism: Acupuncture Today; 2001 [Available from: https://acupuncturetoday.com/article/27779-the-early-diagnosis-and-treatment-of-hypothyroidism]. Journal of Complementary Therapies in Health 2026: 4(1). 9 of 9 Tomas M.S., Nunes C., Moreira G.R., Silva R.O., Santos S., Montenegro R. Efficacy and Feasibility of Acupuncture-Related Treatments for Anxiety and Depression in Hashimoto Thyroiditis: A Review. doi:10.5281/zenodo.17956663 23. Si W. Meta-analysis of Acupuncture-Related Therapy Versus Western Drug Replacement Therapy in the Treatment of Hashimoto's Thyroiditis. Journal of Alternative, Complementary & Integrative Medicine. 2022;8(7):1-7. doi: https://doi.org/10.24966/acim-7562/100290 24. Matos LC, Machado JP, Monteiro FJ, Greten HJ. Understanding Traditional Chinese Medicine Therapeutics: An Overview of the Basics and Clinical Applications. Healthcare (Basel, Switzerland). 2021;9(3). doi: https://doi.org/10.3390/healthcare9030257 25. Wang S, Yang C, Zeng W, Tian H, Du S, Zhao J. Acupuncture treatment for Hashimoto's thyroiditis: An exploratory randomized controlled trial. Integr Med Res. 2024;13(1):101023. doi: https://doi.org/10.1016/j.imr.2024.101023 26. Yu D, Bo L, Yi L. Progress in the Treatment of Hashimoto's Thyroiditis with Traditional Chinese Medicine. Academic Journal of Medicine & Health Sciences. 2024;5(1). doi: https://doi.org/10.25236/AJMHS.2024.050114 27. Qiao X, Liu B, Mu S, Xu C, Yang P, Yang L, et al. [Acupoint application for Hashimoto's thyroiditis with liver-qi stagnation: a randomized controlled trial]. Zhongguo zhen jiu = Chinese acupuncture & moxibustion. 2024;44(5):513-20. doi: https://doi.org/10.13703/j.0255-2930.20230916-k0001 28. Wang X, Li Y, Xie H, Dai Z, Ma L, Zhu X, et al. Effect of acupuncture on Hashimoto thyroiditis: A systematic review and metaanalysis. Medicine (Baltimore). 2024;103(9):e37326. doi: https://doi.org/10.1097/MD.0000000000037326 29. Danni Z, Hong YL, Qi FJ. Clinical study of "Guben Tongjing" acupuncture combined with bridge bow manipulation in the treatment of Hashimoto's thyroiditis. World J Integr Tradit Chin West Med. 2021;16(6):1112-8. 30. Danni Z, Hong YL, Wang YC, editors. Clinical analysis of acupuncture combined with bridge arch manipulation in the treatment of 62 cases of hashimoto thyroiditis from liver, spleen and kidney. New Era, New Thinking, New Leap Forward, New Development: A Retrospective of the 2019 Annual Meeting and 40th Anniversary of the China Association of Acupuncture and Moxibustion; 2019; Wuhan, Hubei, China. 31. Luzina C, Chju L. Ultrasound Scans of Autoimmune Thyroiditis Patients Receiving Acupuncture Treatment. Reflexology. 2003 4(7):56-9.