Traditional Chinese Medicine for Graves' Disease: Clinical Efficacy, Pharmacological Mechanisms, and Challenges

Graves' disease (GD) is a common autoimmune disorder affecting the thyroid gland and is the most common cause of hyperthyroidism and thyrotoxicosis. Given the limitations of current conventional antithyroid therapy for GD, including side effects and relapse concerns, exploring alternative therapeutic options, such as Traditional Chinese Medicine (TCM), is of clinical interest. TCM, with its advantages of multi-component, multi-target actions and relatively mild side effects, has become a promising alternative therapy for GD.

This review aims to systematically discuss the clinical efficacy of Chinese herbal formulas, single herbs, and their isolated active constituents reported in the literature over the past two decades for the treatment of GD, summarize the molecular mechanisms of treatment, conduct a safety evaluation, clarify the potential advantages of TCM in GD therapy, and provide insights for future TCM-based GD treatment strategies.

This review was conducted according to the PRISMA 2020 statement. We searched PubMed, Web of Science, CNKI, and Wanfang Data from January 2005 to December 2025 for randomized controlled trials (RCTs) evaluating TCM interventions for Graves 'disease. The references included in this review were classified into five hierarchical levels according to their evidentiary nature and usage: clinical evidence (RCTs) for clinical efficacy evaluation, preclinical in vivo and in vitro evidence for mechanistic support, computational predictions (network pharmacology) for bioactive compound annotation, and traditional-use records for ethnopharmacological background.

Numerous studies have shown that Chinese herbal formulas, single herbs, and their isolated active constituents have potential therapeutic benefits in the management of GD. These benefits are associated with reducing antibody levels, modulating immune homeostasis, inducing apoptosis of thyroid follicular cells, regulating gut microbiota, exerting antioxidant and anti-inflammatory actions, among others. The reported signaling pathways and targets include Bcl-2/Bax, Fas/FasL, Caspase-3/Caspase-8, PI3K/Akt and Raf/MEK/ERK, among others.

TCM, backed by extensive clinical experience, represents a promising therapeutic strategy for GD. When combined with conventional antithyroid therapy, TCM has demonstrated favorable efficacy in the majority of clinical studies on GD. Future research should prioritize elucidating the precise molecular mechanisms of immune regulation, identifying the specific active constituents responsible for efficacy, and establishing standardized protocols to strengthen the theoretical and scientific foundation for TCM in GD treatment.