Traditional Chinese Medicine as an Adjunct in Hyperthyroidism Management: A Narrative Review of Pathophysiology, Proposed Mechanisms, and Clinical Evidence.

Hyperthyroidism, characterized by elevated serum thyroxine levels, can be classified into overt and subclinical forms. Untreated hyperthyroidism poses substantial health risks. Antithyroid drugs, radioactive iodine, and surgery are established conventional therapeutic options; however, their clinical application may be limited by relapse, adverse effects, contraindications, or patient preference. This narrative review examines the epidemiology of hyperthyroidism, particularly its association with iodine status, strong genetic predisposition, clinical manifestations predominantly seen in women of reproductive age, and diagnostic strategies. Pathophysiological mechanisms of different hyperthyroidism subtypes, including Graves' disease and thyrotoxicosis caused by hyperfunctioning thyroid nodules, are discussed in detail. Furthermore, the perspective of Traditional Chinese Medicine (TCM) is explored, which attributes hyperthyroidism to Gan-Qi (liver-qi) disturbance and identifies exuberant liver fire as a core pathogenic factor. Multi-faceted mechanisms of TCM interventions, largely derived from network-pharmacology, pre-clinical findings and limited clinical data, represent proposed, hypothesis-generating pathways rather than firmly confirmed clinical effects. Available small-sized and heterogeneous randomized controlled trials suggest possible adjunctive benefits of TCM formulas and integrative therapies, such as Gardenia Qinggan Decoction combined with acupuncture, yet the overall certainty of evidence remains limited. Finally, this review highlights challenges in the standardization of TCM interventions, and underscores the necessity for unified quality-control metrics and standardized syndrome-differentiation criteria. Long-term comparative data evaluating sustained clinical outcomes of TCM-integrated management are still required.