What Should Be Considered in Traditional Chinese Medicine (TCM) Treatment of Thyroid Nodules?
Dec 27, 2021
Source: Cainiu Health
Dr. Li Feng
Introduction
In Traditional Chinese Medicine (TCM), thyroid nodules fall under the category of “Ying disease” (goiter). Their development is primarily associated with improper diet and environmental factors (e.g., water and soil quality), as well as emotional injury. Constitutional factors also play a role. Regarding the pathogenesis of tumors, treatment should appropriately employ strategies to regulate Qi and resolve phlegm, dissipate goiter and disperse nodules, while simultaneously promoting blood circulation to remove stasis and nourishing yin to clear fire.
Thyroid nodules are not a distinct disease but rather a descriptive term for abnormal proliferations within the thyroid gland. They represent a common clinical manifestation observed across numerous thyroid disorders. Simply put, a thyroid nodule is an abnormal mass—regardless of size or benign/malignant nature—that develops within thyroid tissue.
What Should Be Considered in Traditional Chinese Medicine (TCM) Treatment of Thyroid Nodules?
Current Western medical approaches to thyroid nodules include: active surveillance for small, benign nodules; surgical excision for larger benign nodules causing compressive symptoms; and various treatment modalities—including medications, surgery, radioiodine therapy, and thermal ablation—for functionally active nodules. Malignant nodules are typically managed surgically, with options including conventional open surgery, endoscopic surgery, and the latest robotic-assisted surgery.
Because thyroid nodules may occur in virtually all thyroid diseases—and any thyroid disorder can manifest as a nodule—the underlying etiologies vary significantly, and symptom presentation and TCM syndrome patterns differ markedly depending on individual constitution. Consequently, a single therapeutic approach or formula cannot universally prevent or treat thyroid nodules. In TCM, treatment of any disease emphasizes organ-system pattern differentiation, careful identification of root causes, precise analysis of pathomechanisms, and meticulous assessment of imbalances among pathogenic and protective factors, yin and yang, qi and blood, and body fluids.
In TCM theory, thyroid nodules fall under the category of “Ying disease” (goiter). Its pathogenesis is primarily associated with improper diet and environmental factors (e.g., water and soil quality), emotional injury, and constitutional predisposition.
Regarding the pathomechanism of tumor formation, appropriate TCM strategies include regulating qi flow, resolving phlegm, dissipating goiter, dispersing nodules, promoting blood circulation to remove stasis, nourishing yin, and clearing fire. Common TCM syndrome patterns associated with goiter/nodules include: Qi Stagnation and Phlegm Obstruction, Phlegm Accumulation with Blood Stasis, Exuberant Liver Fire, and Heart-Liver Yin Deficiency. Corresponding herbal formulas include Si Hai Shu Yu Wan (Four Seas Soothing Depression Pill), Hai Zao Yu Hu Tang (Kelp Jade Pot Decoction), Zhi Zi Qing Gan Tang combined with Xiao Luo Wan (Gardenia Liver-Clearing Decoction plus Dissolving Scrofula Pills), and Yi Guan Jian (Unity Decoction) with modifications.
One critical point deserves special attention: Historically, many classical TCM formulas for goiter—such as Hai Zao Wan (Kelp Pill), Hai Zao Yu Hu Dan (Kelp Jade Pot Pill), and Wei Bu Jiu (Tail-Compensating Pill)—contained iodine-rich herbs. This practice was largely attributable to widespread iodine deficiency at the time. However, since China implemented nationwide universal salt iodization in 1996, iodine deficiency has been essentially eradicated; indeed, some regions now face issues of iodine excess. Research indicates that both iodine deficiency and iodine excess pose risks to thyroid health—particularly for individuals genetically or otherwise predisposed to thyroid disease. Therefore, modern clinical practice should not rigidly adhere to ancient formulas. Modern pharmacological studies reveal that kelp (Hai Zao) is extremely rich in iodine. While it may transiently suppress thyroid hormone release, prolonged use leads to adaptive escape from iodide-induced inhibition, resulting in accelerated thyroid hormone synthesis, progressive intrathyroidal hormone accumulation, and excessive systemic hormone release—potentially triggering recurrent hyperthyroidism and symptom rebound. Consequently, iodine-containing herbs such as kelp are generally discouraged in contemporary management of thyroid nodules. Notably, formulas like Si Hai Shu Yu Wan contain multiple high-iodine ingredients—including kelp (Hai Zao), seaweed (Hai Dai), cuttlefish bone (Hai Piao Xiao), and clamshell (Hai Ge Ke)—and thus warrant particular caution.
We hope the above information is helpful. Wishing you a joyful and healthy life!
