Study aim: To assess the effectiveness of different acupuncture methods (manual, laser, acupoint embedding) combined with standard medication in reducing fatigue and improving specific biochemical markers in hypothyroidism patients. Design: This is a Phase III, four-arm, single‑blinded(assessor and analyst) randomized clinical trial involving 100 patients. Randomization: Permuted block randomization (blocks of 4 and 6), with allocation concealment via SNOSE envelopes. Arms: Manual Acupuncture (MA) + Levothyroxine (LT4): 2 times/week for 6 weeks Acupoint Embedding (AET) + LT4: 1 session Laser Acupuncture (LA) + LT4: 2 times/week for 6 weeks Control: LT4 only. Settings and conduct: Study Type: Phase III, randomized, four-arm clinical trial. Location: Acupuncture Clinic of Imam Reza Hospital, Mashhad, Iran. Patients: 100 patients with hypothyroidism. Randomization: Permuted block randomization method, SNOSE envelopes. Groups: MA, AET, LA, control (Levothyroxine only). Intervention Period: 6 weeks. Blinding: Assessors, laboratory personnel, statistical analysts blinded. Patients and practitioners not blinded. Participants/Inclusion and exclusion criteria: Age 18-65, primary hypothyroidism, stable levothyroxine, normal TSH, severe fatigue (FSS≥4). Commitment to protocol and consent / Secondary/central hypothyroidism, history of thyroid cancer, pregnancy/lactation. Severe illnesses, specific medications (steroids, immunosuppressants...). Recent levothyroxine dose change, recent acupuncture/embedding/laser therapy. Coagulation/anticoagulation issues, skin problems, non-compliance. Intervention groups: MA + Standard: 12 MA sessions over 6 weeks + Levothyroxine AET + Standard: 1 single AET session + Levothyroxine LA + Standard: 12 LA sessions over 6 weeks + Levothyroxine Control: Levothyroxine only Main outcome variables: Primary : Mean change in FSS Secondary: TSH, T4, NLR, PLR, SII, lipid profile, TyG , FBS, QoL