Re: Herbal Therapy AJBHT Shows Promise For Patients With Graves' Disease
Lee B-C, Kang S-I, Ahn Y-M, Doo H-K, Ahn S-Y. An alternative therapy for Graves' disease: clinical effects and mechanisms of an herbal remedy. Biol Pharm Bull. April 2008;31(4): 5883-587.
Graves' disease, the most common form of hyperthyroidism, is treated most often by surgery, radioiodine treatment, or antithyroid drugs.
Antithyroid drugs are associated with minor adverse side effects as well as potentially life-threatening or even lethal complications. Most patients with adverse side effects can be given other antithyroid drugs or radioiodine therapy; some patients choose to try herbal medicines.
These authors conducted a clinical trial to investigate the clinical effects of an aqueous extract of ahnjeonbaekho-tang (AJBHT) in patients with Graves' disease who suffered side effects from antithyroid drugs. Additionally, they conducted an in vitro study to analyze the effects of AJBHT on cell proliferation, DNA synthesis, and the expression of adenosine 3',5'-cyclic monophosphate (cAMP), thyroxine (T4), thyroid-stimulating hormone (TSH), thyroglobulin (Tg), and thyroid peroxidase (TPO) in TSH-activated Fisher rat thyroid (FRTL-5) cells.
The study was conducted between February 2004 and June 2006 in the Oriental Medical Hospital at Kyung Hee University in Seoul, Korea. It included 22 patients who had been diagnosed with Graves' disease and had previously experienced adverse side effects from antithyroid drugs (methimazole and prophylthiouracil). Side effects (and number of patients having them) from the drugs included rash (8), urticaria (5), arthralgia (3), gastrointestinal upset (3), agranulocytosis (2), and hepatotoxicity (1).
Of the 22 patients enrolled in the study, 4 dropped out for various reasons. The remaining 18 (7 men and 11 women) were followed for 3 months. Their mean age was 32.06 ± 6.71 years, and their body mass index was 20.81 ± 2.91. Patients were treated with AJBHT (aqueous extracts 6 g) 3 times a day for 3 months. No serious side effects or drug reactions resulted.
Twelve patients started without a washout period because they had not taken antithyroid drugs for more than 2 months and had abnormal thyroid hormone levels, and 10 patients started after a washout period. A clinical and laboratory assessment (serum levels of free thyroxine [FT4], triiodothyronine [T3], TSH, and TSH receptor autoantibodies [TRAb]) was performed at baseline and then monthly for 3 months.
AJBHT extract powder is a dried mixture of the following raw materials: kudzu (Pueraria thunbergiana), Chinese skullcap (Scutellaria baicalensis), gypsum, platycodon (Platycodon grandiflorum), Angelica tenuissima, Chinese cimicifuga (Actaea cimicifuga syn. Cimicifuga foetida), fragrant angelica (Angelica dahurica), and Chinese licorice (Glycyrrhiza uralensis) in a ratio of 5:2:1:1:1:1:1:1. AJBHT extract powder was obtained from the Department of Pharmaceutical Preparation of Oriental Medicine of the Oriental Medical Hospital. The air-dried and crushed materials were added to distilled water, and extraction was performed by heating for 4 hours at 100° C. Then the extract was concentrated with a rotary evaporator (Model NE-1, EYELA Co., Japan) and dried with a freeze dryer (Model FD-1, EYELA Co., Japan). The collection rate of the final aqueous extracts was 11.8%.
For the in vitro study, FRTL-5 cells were provided by Dr. Minho Song (Department of Internal Medicine, Chungnam National University).
Statistical comparisons were performed using the paired t-test for the clinical trial and one-way analysis of variance (ANOVA) followed by Tuckey's post hoc test for the in vitro study. The authors present all data as the mean ± standard deviation. All P values are two-tailed, and significance was defined as P < 0.05.
The authors report that the AJBHT improved thyroid hormone based on T3 measurements in 17 patients (94.4%) (P < 0.0001); FT4 levels in 15 patients (83.3%) (P=0.0012); and TSH in 14 patients (77.8%) (P=0.0370). However, say the authors, compared with the improvement rates for T3 and FT4 levels, TSH levels had a relatively poor improvement rate. This may be due to the short intervention period of this study.
Other findings reported by the authors include the achievement of biochemical euthyroidism with AJBHT treatment based on levels of T3 in 10 patients (55.5%), FT4 in 12 patients (66.7%), and TSH in 4 patients (22.2%). No significant changes were seen, however, in TRAb levels between the baseline (47.94% ± 21.01%) and 3-month (40.56% ± 22.50%) measurements.
The authors report that in vitro, AJBHT at 30 mcg/ml "significantly inhibits FRTL-5 cell proliferation, DNA synthesis, cyclic AMP production, T4 synthesis, and the expression of Tg mRNA in comparison with the control."
"The results from our clinical and in vitro studies suggest that AJBHT might suppress T4 synthesis by modulating cyclic AMP and Tg levels, making it a possible alternative therapy for Graves' disease patients who have side effects from antithyroid drugs," say the authors. However, they acknowledged the "need to perform a randomized controlled trial with general Graves' disease patients."
Herbal Formula May Counter Graves' Disease
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