Chinese herbal medicines for hypothyroidism

Study protocol to develop a core outcome set for thyroid dysfunction to bridge the unmet needs of patient-centred care

INTRODUCTION

Thyroid dysfunctions (TD) are common medical conditions affecting all global populations. Improved healthcare leading to increasing survival rates and delayed diagnosis rendered significant burden of the disease in the increasing number of patients with TD with comorbid illnesses. Therefore, reducing the burden of TD and improving the quality of care are crucial. Existing poor-quality data that guide evidence-based decisions only provide a fragmented picture of clinical care. The different outcomes across studies assessing the effectiveness of treatments impede our ability to synthesise results for determining the most efficient treatments. This project aims to produce a core outcome set (COS), which embeds the multiple complex dimensions of routine clinical care for the effectiveness studies and clinical care of adult patients with TD.

METHODS AND ANALYSIS

This mixed-method project has two phases. In phase 1, we will identify a list of patient-reported and clinical outcomes through qualitative research and systematic reviews. In phase 2, we will categorise the identified outcomes using the Core Outcome Measures in Effectiveness Trials taxonomy of core domains and the International Classification of Functioning, Disability and Health. We will develop questionnaires from the list of outcomes identified from each domain for the two-round online Delphi exercise, aiming to reach a consensus on the COS. The Delphi process will include patients, carers, researchers and healthcare participants. We will hold an online consensus meeting involving representatives of all key stakeholders to establish the final COS.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the Ethics Committee for Research Involving Human Subjects, Universiti Putra Malaysia and the Research Ethics Committee, National University of Malaysia. This proposed COS in TD will improve the value of data, facilitate high-quality evidence synthesis and evidence-based decision-making. Furthermore, we will present the results to participants, in peer-reviewed academic journals and conferences.

REGISTRATION DETAILS

Core Outcome Measures in Effectiveness Trials (COMET) Initiative database registration: http://www.comet-initiative.org/studies/details/1371.

Application of Proteomics and Metabonomics to Reveal the Molecular Basis of Atractylodis Macrocephalae Rhizome for Ameliorating Hypothyroidism Instead of Hyperthyroidism

As the treatments of diseases with Chinese herbs are holistic and characterized by multiple components, pathways, and targets, elucidating the efficacy of Chinese herbs in treating diseases, and their molecular basis, requires a comprehensive, network-based approach. In this study, we used a network pharmacology strategy, as well as in vivo proteomics and metabonomics, to reveal the molecular basis by which Atractylodis macrocephalae rhizome (AMR) ameliorates hypothyroidism. Eighteen main compounds from AMR and its fractions (volatile oil fraction, crude polysaccharides fraction, lactones fraction, oligosaccharide fraction, and atractyloside fraction) were identified by HPLC, and their targets were screened using the TCMSP database and Swiss Target Prediction. Disease targets were gathered from the TTD, CTD and TCMSP databases. Hub targets were screened by different plug-ins, such as Bisogene, Merge, and CytoNCA, in Cytoscape 3.7.1 software and analyzed for pathways by the DAVID database. Hypothyroidism and hyperthyroidism pharmacological models were established through systems pharmacology based on proteomic and metabolomic techniques. Finally, AMR and its fractions were able to ameliorate the hypothyroidism model to different degrees, whereas no significant improvements were noted in the hyperthyroidism model. The lactones fraction and the crude polysaccharides fraction were considered the most important components of AMR for ameliorating hypothyroidism. These amelioration effects were achieved through promoting substance and energy metabolism. In sum, the integrative approach used in this study demonstrates how network pharmacology, proteomics, and metabolomics can be used effectively to elucidate the efficacy, molecular basis, and mechanism of action of medicines used in TCM.

Herbal preparations in the management of hypothyroidism in Unani medicine

Hypothyroidism is the most common thyroid disorder, affects women more frequently, and incidence increases with age. The prevalence of hypothyroidism in developed countries is around 4-5%, whereas, in India, it is about 11%. The common symptoms of hypothyroidism in adults are weight gain, fatigue, lethargy, cold intolerance, constipation, change in voice, and dry skin. It can affect all systems of the body. Diagnosis is mainly based on clinical history and laboratory investigations. Untreated hypothyroidism increases morbidity and mortality. In conventional medicine, the treatment of choice is Levothyroxine, whereas in Unani System of Medicine, pharmacotherapy consists of single and compound drugs. Single drugs are selected as per the constitution (Mizaj) of drugs as opposed to the abnormal constitution (Su-e-Mizaj) of disease and its pathology. Some drugs increase the basal metabolic rate whereas some evacuate the morbid material from the body by the action of purgation. The drugs are used either in a single form or as a prescription of more than one drug in the form of decoction (Joshandah), infusion (Kheshandah), or powder (Safoof). This review aims at providing comprehensive information regarding various drugs used in Unani system of medicine that is used in the management of thyroid dysfunction.

Herbal preparations in the management of hypothyroidism in Unani medicine

Hypothyroidism is the most common thyroid disorder, affects women more frequently, and incidence increases with age. The prevalence of hypothyroidism in developed countries is around 4-5%, whereas, in India, it is about 11%. The common symptoms of hypothyroidism in adults are weight gain, fatigue, lethargy, cold intolerance, constipation, change in voice, and dry skin. It can affect all systems of the body. Diagnosis is mainly based on clinical history and laboratory investigations. Untreated hypothyroidism increases morbidity and mortality. In conventional medicine, the treatment of choice is Levothyroxine, whereas in Unani System of Medicine, pharmacotherapy consists of single and compound drugs. Single drugs are selected as per the constitution (Mizaj) of drugs as opposed to the abnormal constitution (Su-e-Mizaj) of disease and its pathology. Some drugs increase the basal metabolic rate whereas some evacuate the morbid material from the body by the action of purgation. The drugs are used either in a single form or as a prescription of more than one drug in the form of decoction (Joshandah), infusion (Kheshandah), or powder (Safoof). This review aims at providing comprehensive information regarding various drugs used in Unani system of medicine that is used in the management of thyroid dysfunction.