Hypothyroidism (underactive thyroid) — Wokingham, Berkshire

1. Overview

Hypothyroidism — underactive thyroid — is one of the most common endocrine disorders in the UK, affecting approximately 2% of the population and up to 5% of women over 60. The thyroid gland fails to produce sufficient thyroid hormone (T3 and T4) to meet the body’s metabolic needs, resulting in a systemic slowing of metabolic processes that produces fatigue, weight gain, depression, cold intolerance and cognitive slowing. The most common underlying cause is Hashimoto’s thyroiditis — an autoimmune condition in which the immune system attacks thyroid tissue, progressively impairing its function.

Conventional treatment is levothyroxine (synthetic T4) replacement therapy, which normalises TSH and T4 levels in most patients. However, a significant proportion of patients — estimated at 10–15% — continue to experience persistent symptoms (fatigue, brain fog, weight, mood disturbance) despite achieving normal TSH levels on levothyroxine. Furthermore, levothyroxine does not address the underlying autoimmune process in Hashimoto’s thyroiditis, and thyroid antibody levels (TPOAb, TGAb) remain elevated throughout treatment. Acupuncture and Chinese herbal medicine address both the residual symptoms and the autoimmune root of Hashimoto’s, and are used alongside levothyroxine rather than as a replacement for it.

2. Symptoms

Fatigue and lethargy — profound, persistent fatigue is the cardinal symptom; it does not resolve with rest and is often described as a deep heaviness; it reflects the generalised metabolic slowdown caused by insufficient thyroid hormone and corresponds to the Kidney Yang deficiency and Qi deficiency patterns of TCM
Weight gain and difficulty losing weight — reduced metabolic rate leads to weight gain despite unchanged diet; a tendency towards fluid retention (myxoedema) contributes to facial puffiness and swelling of the extremities; in TCM terms this reflects Phlegm-Damp accumulation from Spleen and Kidney Yang deficiency
Cold intolerance — abnormal sensitivity to cold — feeling cold when others are comfortable, cold hands and feet, and cold lower back — is one of the most characteristic symptoms; it directly reflects the Yang deficiency that is central to the TCM understanding of hypothyroidism
Depression and mood disturbance — hypothyroidism is a significant and frequently overlooked cause of depression; approximately 40% of hypothyroid patients have depressive symptoms; the mechanism involves reduced serotonin synthesis and impaired neurotransmitter function secondary to thyroid hormone deficiency
Brain fog and cognitive slowing — poor memory, difficulty concentrating, slowed thinking and mental fatigue; thyroid hormone is essential for normal brain metabolism; these symptoms frequently persist in patients on levothyroxine and are among the most common reasons patients seek complementary treatment
Dry skin, hair loss and brittle nails — reduced cellular turnover produces dry, rough, thickened skin; diffuse hair thinning (particularly loss of the outer third of the eyebrows — Hertoghe’s sign) and brittle nails; in TCM terms, these reflect Kidney Essence and Blood deficiency failing to nourish the skin, hair and nails
Constipation — reduced gut motility from metabolic slowing produces chronic constipation; this corresponds to the TCM pattern of Kidney Yang deficiency failing to warm and move the intestines
Menstrual irregularity — hypothyroidism commonly disrupts the menstrual cycle, producing heavy periods, irregular cycles or absent periods; it is an important and often missed cause of menstrual irregularity and fertility problems
Neck discomfort and goitre — in Hashimoto’s thyroiditis, the thyroid may be enlarged or nodular; patients commonly report a sensation of pressure, tightness or discomfort in the neck; in TCM, this corresponds to Phlegm and Qi stagnation accumulating in the neck channels

3. Causes

Hashimoto’s thyroiditis (autoimmune) — the most common cause in iodine-sufficient countries; an autoimmune process in which T-helper lymphocytes recognise thyroid antigens as foreign and mount an inflammatory response against thyroid tissue; TPO antibodies (TPOAb) and thyroglobulin antibodies (TGAb) are the serological markers; progressive immune-mediated destruction of thyroid parenchyma leads to declining thyroid hormone production over years; Hashimoto’s is 7–10 times more common in women than men and has a strong hereditary component
Post-thyroiditis — transient hypothyroidism can follow subacute (de Quervain’s) thyroiditis or post-partum thyroiditis; post-partum thyroiditis affects approximately 5–7% of women in the year after delivery and can produce a hypothyroid phase that may become permanent
Iatrogenic (treatment-induced) — hypothyroidism following thyroid surgery (total or partial thyroidectomy), radioactive iodine treatment for hyperthyroidism or Graves’ disease, or external beam radiation to the neck
Iodine deficiency — the most common cause globally (though uncommon in the UK); iodine is essential for thyroid hormone synthesis; marginal iodine deficiency is more prevalent than commonly recognised and may contribute to subclinical hypothyroidism
Subclinical hypothyroidism — elevated TSH with normal T4; affects approximately 3–8% of the population; many patients have symptoms despite technically “normal” thyroid hormones; TCM treatment is particularly appropriate at this stage, addressing the energetic and constitutional pattern before overt hormone deficiency develops

4. Hypothyroidism in Chinese medicine

In traditional Chinese medicine, hypothyroidism corresponds most closely to a pattern of Kidney Yang deficiency — a depletion of the warming, activating force that drives all metabolic processes in the body. The Kidney is the root of all Yang in TCM, the source of heat and transformation that warms the organs, activates digestion and maintains the metabolic rate. When Kidney Yang is depleted, all biological processes slow — precisely the metabolic slowdown that characterises clinical hypothyroidism. The specific patterns encountered are:

Kidney Yang deficiency — the core pattern; profound fatigue, cold intolerance, cold lower back, nocturia, oedema of the lower limbs, cold hands and feet, constipation, low libido; a pale swollen tongue with a white coat and a deep, slow, weak pulse in the Chi (Kidney) position; corresponds to overt hypothyroidism; treatment warms and tonifies Kidney Yang using Jin Gui Shen Qi Wan and You Gui Wan modifications
Spleen and Kidney Yang deficiency — Kidney Yang deficiency impairs the Spleen’s warming and transforming function; poor appetite, bloating, loose stools, fatigue worse after eating, oedema, weight gain from fluid retention; treatment tonifies both Spleen and Kidney Yang and resolves Phlegm-Damp using Zhen Wu Tang and Li Zhong Wan modifications
Qi stagnation and Phlegm accumulation in the neck (Ying / goitre pattern) — the pattern underlying the thyroid enlargement and neck discomfort of Hashimoto’s; emotional stress causes Liver Qi to stagnate, which, combined with Spleen-generated Phlegm, accumulates in the throat and neck channels producing goitre, neck tightness and nodularity; treatment moves Qi, transforms Phlegm and disperses masses using herbs such as Xia Ku Cao (Prunella vulgaris), Zhe Bei Mu (Fritillaria), Xuan Shen (Scrophularia) and Kun Bu (Ecklonia kelp)
Kidney Yang and Yin deficiency (mixed pattern) — in Hashimoto’s thyroiditis, particularly in perimenopausal women, chronic autoimmune inflammation depletes both Yin and Yang simultaneously; hot flushes and cold lower back, fatigue alongside night sweats, oedema alongside dry skin; Er Xian Tang addresses the mixed pattern; this is particularly relevant for perimenopausal women with Hashimoto’s
Heart and Kidney Yang deficiency — the pattern when cardiovascular features accompany hypothyroidism; bradycardia, palpitations, breathlessness on exertion, oedema, depression; treatment warms Heart and Kidney Yang using Zhi Gan Cao Tang modifications

5. Acupuncture for hypothyroidism

Acupuncture is used alongside levothyroxine therapy to address both the residual symptoms that persist despite normalised TSH and the underlying autoimmune process in Hashimoto’s thyroiditis. Its mechanisms include:

Regulating the hypothalamic-pituitary-thyroid (HPT) axis — acupuncture modulates the HPT axis through its effects on the hypothalamus and pituitary, normalising TSH secretion and improving thyroid hormone production; in patients with subclinical hypothyroidism or borderline TSH, this may reduce the TSH without requiring dose escalation of levothyroxine
Reducing thyroid antibody levels — acupuncture modulates the autoimmune response in Hashimoto’s thyroiditis, reducing TPOAb and TGAb levels; a 2024 systematic review and meta-analysis by Wang et al., published in Medicine (Baltimore) and including 14 RCTs with 1,020 patients, found acupuncture significantly reduced TPOAb, TGAb, and TSH compared to levothyroxine alone, while also improving FT3 and FT4; this represents a clinically important advantage over levothyroxine monotherapy, which does not reduce antibody levels
Warming Yang and improving circulation — acupuncture at constitutional warming points increases peripheral blood flow and body temperature, directly addressing the cold intolerance and fatigue of Kidney Yang deficiency; moxibustion at GV4 (Mingmen), CV4 (Guanyuan), CV6 (Qihai) and ST36 (Zusanli) is particularly effective for this
Dispersing Phlegm and Qi stagnation from the neck — local needling around the thyroid gland, along the Large Intestine channel (LI11 Quchi, LI14 Bi Nao) and at thyroid-specific points improves local circulation, reduces thyroid inflammation and disperses the Phlegm-Qi accumulation that produces neck tightness and goitre; a 2024 exploratory RCT by Wang et al. in Integrative Medicine Research found Hand Yangming Meridian Penetrating Acupuncture significantly improved symptoms and reduced TGAb levels in Hashimoto’s hypothyroidism patients
Improving mood, energy and cognitive function — acupuncture raises serotonin and endorphin levels, improves HPA axis regulation and enhances brain metabolism, directly addressing the depression, brain fog and fatigue that frequently persist in patients on levothyroxine

Moxibustion is a particularly important modality for hypothyroidism, as its warming action directly addresses the Kidney Yang deficiency at the root of the condition. A multi-centre RCT demonstrated that indirect moxibustion significantly reduced TGAb and TPOAb levels in hypothyroid patients after 12 weeks. Moxibustion at GV4 (Mingmen), BL23 (Shenshu) and CV4 (Guanyuan) warms Kidney Yang; moxibustion can also be applied locally over the thyroid region to improve circulation and reduce inflammatory activity.

6. Chinese herbal medicine for hypothyroidism

Chinese herbal medicine is the most comprehensive TCM treatment for hypothyroidism, providing daily systemic treatment that addresses both the thyroid hormone insufficiency (Yang and Qi deficiency) and, in Hashimoto’s, the autoimmune process driving progressive thyroid destruction. Herbs are taken alongside, not instead of, levothyroxine, and can reduce the dose required over time in some patients. Formulae are individually tailored to the specific TCM pattern:

You Gui Wan modifications (Restore the Right Kidney Pill) — the primary formula for profound Kidney Yang deficiency; the most Yang-warming formula in the TCM repertoire; warms Ming Men Fire, tonifies Kidney Yang and Essence, nourishes Blood; contains Fu Zi, Rou Gui, Lu Jiao Jiao, Shu Di Huang, Du Zhong, Tu Si Zi and Gou Qi Zi; used for overt hypothyroidism with pronounced cold, fatigue and constitutional depletion
Jin Gui Shen Qi Wan modifications (Kidney Qi Pill) — the classical foundational formula for Kidney Yang deficiency; more moderate than You Gui Wan; used for subclinical hypothyroidism or mild to moderate hypothyroidism; warms Kidney Yang within nourishing Kidney Yin; adds Phlegm-dispersing herbs (Xia Ku Cao, Zhe Bei Mu, Kun Bu) for goitre and neck accumulation
Xia Ku Cao (Prunella vulgaris) — the most important single herb in Chinese medicine for thyroid conditions; clears Liver Fire, softens hardness and disperses thyroid nodules and goitre; has documented anti-inflammatory and immunomodulatory properties relevant to Hashimoto’s autoimmune process; used in all Hashimoto’s formulas regardless of the base pattern
Zhen Wu Tang modifications (True Warrior Decoction) — for Spleen and Kidney Yang deficiency with prominent water retention and oedema; contains Fu Zi, Bai Zhu, Fu Ling, Bai Shao and Sheng Jiang; particularly suited to hypothyroid patients with significant weight gain from fluid retention
Er Xian Tang modifications (Two Immortals Decoction) — for the mixed Yin-Yang deficiency pattern common in perimenopausal women with Hashimoto’s; addresses both the cold and heat aspects simultaneously

Herbs are prescribed as pharmaceutical-grade granules from Sun Ten (Taiwan), dissolved in warm water and taken daily. An online Chinese herbal consultation is available for patients who cannot attend in person.

7. Self-care tips

Take levothyroxine correctly — levothyroxine must be taken on an empty stomach (at least 30–60 minutes before food or other medications); calcium, iron supplements, antacids and certain foods (soy, coffee, high-fibre foods) significantly impair levothyroxine absorption; Chinese herbal granules should be taken at a different time of day from levothyroxine
Avoid goitrogenic foods in excess — raw cruciferous vegetables (broccoli, cabbage, kale, Brussels sprouts) contain goitrogens that can interfere with thyroid hormone production in large quantities; cooking largely deactivates these compounds; moderate consumption is unlikely to be problematic but excessive raw consumption should be avoided in hypothyroid patients
Selenium and vitamin D — selenium is the most evidence-based nutritional supplement for Hashimoto’s thyroiditis; it reduces TPOAb levels by supporting the selenoprotein-dependent antioxidant system that protects thyroid cells from autoimmune damage; optimal dose is 200mcg selenium methionine daily; vitamin D deficiency is significantly more prevalent in Hashimoto’s patients and supplementation to optimal levels (100–150 nmol/L) supports immune regulation
Warmth and Yang-supporting lifestyle — in TCM terms, supporting Kidney Yang means avoiding cold exposure (dressing warmly, keeping the lower back and feet warm), avoiding excess cold and raw foods (which consume Yang to digest), avoiding overwork and late nights (which deplete Kidney Jing), and maintaining regular moderate exercise which supports Yang Qi circulation
Manage stress — psychological stress activates the HPA axis and promotes the Th17 immune response that drives autoimmune thyroid inflammation in Hashimoto’s; chronic stress worsens both thyroid antibody levels and symptoms; acupuncture, adequate sleep and stress management directly support thyroid immune health
Regular monitoring — TSH and thyroid antibody levels should be monitored regularly (every 6–12 months once stable); inform your GP or endocrinologist of all herbal medicines taken, as herbal treatment may affect thyroid hormone requirements over time

8. Treatment at my clinic

I treat hypothyroidism and Hashimoto’s thyroiditis at my clinic in Wokingham, Berkshire, using acupuncture, moxibustion and Chinese herbal medicine as an adjunct to levothyroxine therapy. Treatment addresses the Kidney Yang deficiency and Phlegm-Qi accumulation underlying the condition, the autoimmune process driving Hashimoto’s, and the residual symptoms (fatigue, brain fog, weight, mood, cold intolerance) that frequently persist despite normalised TSH on levothyroxine. Related conditions commonly co-treated include menopausal symptoms, depression, chronic fatigue, menstrual irregularity and fertility problems associated with thyroid dysfunction.

Visit the prices page for treatment costs or book an online Chinese herbal consultation if you cannot attend in person.

9. Frequently asked questions

Can acupuncture help hypothyroidism?

Yes, particularly for Hashimoto’s thyroiditis. A 2024 systematic review and meta-analysis of 14 RCTs involving 1,020 patients found that acupuncture combined with levothyroxine significantly reduced TPOAb, TGAb and TSH levels compared to levothyroxine alone, while also improving thyroid hormone levels (FT3, FT4). Acupuncture also addresses the fatigue, depression, cold intolerance and brain fog that frequently persist in patients on levothyroxine with normalised TSH.

Does Chinese herbal medicine replace levothyroxine?

No — Chinese herbal medicine works alongside levothyroxine, not as a replacement for it. Herbs address the underlying Kidney Yang deficiency, the autoimmune process in Hashimoto’s and the residual symptoms that levothyroxine does not treat. In some patients, consistent herbal treatment may reduce the levothyroxine dose required over time, but this should always be done under medical supervision with regular TSH monitoring.

What is Hashimoto’s thyroiditis?

Hashimoto’s thyroiditis is an autoimmune condition and the most common cause of hypothyroidism in the UK. The immune system produces antibodies (TPOAb and TGAb) that attack the thyroid gland, progressively impairing its ability to produce thyroid hormone. Conventional medicine treats the hormone deficiency with levothyroxine but has no treatment for the autoimmune process. Acupuncture and Chinese herbal medicine directly address the autoimmune component, reducing antibody levels over time.

Can hypothyroidism affect fertility?

Yes — hypothyroidism is an important cause of menstrual irregularity, anovulation and infertility. Thyroid hormone is essential for normal ovulation and luteal phase function, and subclinical hypothyroidism is associated with increased miscarriage risk and IVF failure. TSH should be optimised to below 2.5 mIU/L in women trying to conceive. TCM treatment addressing Kidney Yang deficiency supports both thyroid function and reproductive health simultaneously.