Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2022; 10(17): 5690-5701
Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5690
Systematic review of Yougui pills combined with levothyroxine sodium in the treatment of hypothyroidism
Xiao-Pei Liu, Ya-Nan Zhou, Cong-E Tan
Xiao-Pei Liu, Ya-Nan Zhou, Cong-E Tan, School of Basic Medicine, Shaanxi University of Chinese Medicine, Xianyang 712046, Shaanxi Province, China
Author contributions: Tan CE and Liu XP conceptualized and designed the protocol, drafted the initial manuscript and reviewed the manuscript; Liu XP and Zhou YN defined the concepts and search items and performed the data extraction process as well as methodological appraisal of the studies; Zhou YN and Tan CE planned the data extraction and statistical analysis; Liu XP and Tan CE provided critical insights; All authors have approved and contributed to the final written manuscript.
Supported by the National Natural Science Foundation of China, No. 81973754; Shaanxi University of Traditional Chinese Medicine Innovation Team Project, No. 2019-QN06.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cong-E Tan, PhD, School of Basic Medicine, Shaanxi University of Chinese Medicine, Xixian Avenue, Xixian New District, Xianyang 712046, Shaanxi Province, China. tanzime@163.com
Received: October 27, 2021
Peer-review started: October 27, 2021
First decision: February 14, 2022
Revised: March 10, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: June 16, 2022
Processing time: 224 Days and 21.3 Hours
Abstract
BACKGROUND

Yougui pills have long been used to treat hypothyroidism, usually in combination with levothyroxine sodium in clinical treatment, while their clinical efficacy and safety are still controversial when compared to levothyroxine treatment alone.

AIM

To explore the clinical efficacy and safety of Yougui pills combined with levothyroxine sodium in the treatment of hypothyroidism.

METHODS

This meta-analysis was performed in accordance with the PRISMA guidelines. Randomized controlled trials on Yougui pills in the treatment of hypothyroidism published from 2008 to May 2021 were searched in a total of 8 databases (4 databases in Chinese and 4 databases in English). The quality of the included studies was evaluated according to the Cochrane risk assessment tool. Weighted mean difference (WMD) was used for continuous variables, and relative risk (RR) was used for binary variables. Data were extracted, and the meta-analysis was conducted with the statistical software of Stata15.0 and RevMan5.0.

RESULTS

A total of 140 articles were retrieved, and 9 of them were finally included, with a total sample size of 936 cases. The main meta-analysis results are as follows: (1) The group of Yougui pills combined with levothyroxine sodium had a significantly higher overall response rate than the group of levothyroxine sodium (RR = 1.20, 95%CI 1.12, 1.28, P < 0.00001); (2) Yougui pills combined with levothyroxine sodium achieved significantly better efficacy than levothyroxine sodium alone in alleviating adverse symptoms [standard mean difference (SMD) = -1.10, 95%CI: -1.37, -0.84, P < 0.00001]; (3) The level of thyrotropin stimulating hormone in the group of Yougui pills combined with levothyroxine sodium was significantly lower than in the control group of levothyroxine sodium (WMD = -1.38, 95%CI: -2.10, -0.67, P = 0.00001); (4) The level of free triiodothyronine in the group of Yougui pills combined with levothyroxine sodium was higher than that in the control group of levothyroxine sodium (WMD = 0.41, 95%CI: 0.03, 0.79, P = 0.03); (5) The level of free thyroxine in the group of Yougui pills combined with levothyroxine sodium was significantly higher than that in the control group of levothyroxine sodium (SMD = 0.83, 95%CI: 0.44, 1.22, P ≤ 0.0001); and (6) The adverse reactions in the group of Yougui pills combined with levothyroxine sodium were significantly less than those in the control group of levothyroxine sodium (RR = 0.33, 95%CI: 0.20, -0.53, P < 0.00001).

CONCLUSION

In the treatment of hypothyroidism, the combination of Yougui pills with levothyroxine sodium may be better than levothyroxine sodium treatment alone.

Keywords: Yougui pills; Levothyroxine sodium; Hypothyroidism; Systematic review

Core Tip: The combined treatment of Yougui pills and levothyroxine sodium can effectively reduce or eliminate the adverse reactions caused by the use of hormones, increase the secretion of hormones in serum and thus significantly improve the clinical symptoms of hypothyroidism. We recommended the use of levothyroxine sodium in combination with Yougui pills in patients with hypothyroidism.