From the Guidelines
Thyroiditis should be treated based on the specific type and symptoms, with a focus on relieving symptoms and improving quality of life, as the current evidence does not support treatment altering final health outcomes 1.
Treatment Approach
The treatment approach for thyroiditis depends on the type and stage of the disease. For hyperthyroid symptoms, beta-blockers like propranolol (10-40 mg three to four times daily) can provide relief. If hypothyroidism develops, levothyroxine replacement therapy is typically prescribed, starting at 1.6 mcg/kg/day for most adults, with adjustments based on TSH levels every 6-8 weeks until stabilized.
Types of Thyroiditis
The most common forms of thyroiditis include:
- Hashimoto's thyroiditis (chronic autoimmune thyroiditis)
- Subacute thyroiditis
- Postpartum thyroiditis
- Radiation-induced thyroiditis
Monitoring and Management
Regular monitoring of thyroid function is essential for all thyroiditis patients, as the condition can progress from temporary hyperthyroidism to permanent hypothyroidism, particularly in autoimmune forms. Treatment is typically not recommended for patients with TSH levels between 0.1 and 0.45 mIU/L or when thyroiditis is the cause 1.
Key Considerations
- The optimal screening interval for thyroid dysfunction is unknown 1.
- The principal treatment for hypothyroidism is oral T4 monotherapy (levothyroxine sodium) 1.
- Hyperthyroidism is treated with antithyroid medications (such as methimazole) or nonreversible thyroid ablation therapy (for example, radioactive iodine or surgery) 1.
From the Research
Definition and Forms of Thyroiditis
- Thyroiditis is a general term that encompasses several clinical disorders characterized by inflammation of the thyroid gland 2, 3.
- The most common forms of thyroiditis include Hashimoto, postpartum, and subacute thyroiditis 2, 3.
Hashimoto Thyroiditis
- Hashimoto thyroiditis is an autoimmune disorder that presents with or without signs or symptoms of hypothyroidism, often with a painless goiter, and is associated with elevated thyroid peroxidase antibodies 2, 3, 4.
- Patients with Hashimoto thyroiditis and overt hypothyroidism are generally treated with lifelong thyroid hormone therapy 3, 4.
- The dose of levothyroxine (LT4) used for treatment is based on the degree of preserved thyroid functionality and lean body mass, and usually ranges from 1.4 to 1.8 mcg/kg/day 4.
Postpartum Thyroiditis
- Postpartum thyroiditis occurs within one year of delivery, miscarriage, or medical abortion 2, 3.
- It is a transient or persistent thyroid dysfunction that may result in hyperthyroidism, followed by transient or permanent hypothyroidism 2, 3.
- Patients should be monitored for changes in thyroid function, and beta blockers can treat symptoms in the initial hyperthyroid phase 2, 3.
Subacute Thyroiditis
- Subacute thyroiditis is a self-limited inflammatory disease characterized by anterior neck pain 3, 5, 6.
- Treatment of subacute thyroiditis should focus on symptoms, with beta blockers used to treat adrenergic symptoms in the hyperthyroid phase, and nonsteroidal anti-inflammatory drugs or corticosteroids used to treat thyroid pain 3, 5, 6.
- Short-term prednisone treatment may be an alternative strategy for ameliorating moderate-to-severe symptoms of subacute thyroiditis, with a better safety profile compared to 6-week treatment 6.