What is the treatment for Hashimoto's (Hashimoto's thyroiditis)?

From the Guidelines

Hashimoto's thyroiditis is primarily treated with levothyroxine (T4) replacement therapy when it causes hypothyroidism, with the goal of maintaining TSH within normal range and improving quality of life. The typical starting dose for adults is 1.6 mcg/kg/day (usually 75-125 mcg daily), taken on an empty stomach 30-60 minutes before breakfast or at bedtime, at least 4 hours after any interfering medications 1. Dosage is adjusted every 6-8 weeks based on TSH levels, with the goal of maintaining TSH within normal range (typically 0.5-4.0 mIU/L) 1. Treatment is usually lifelong, and patients need regular monitoring with blood tests every 6-12 months once stable. Levothyroxine works by replacing the thyroid hormone that the damaged thyroid can no longer produce adequately. Some patients may benefit from combination therapy with T3 (liothyronine) if symptoms persist despite normal TSH levels, though this remains controversial 1. Beyond medication, managing stress, ensuring adequate selenium intake (200 mcg daily), and addressing related autoimmune conditions may help. Importantly, treatment focuses on hormone replacement rather than stopping the autoimmune process itself, as the damaged thyroid tissue cannot be restored. Pregnant women with Hashimoto's require close monitoring and often need dose increases of 25-50% during pregnancy 1.

Key considerations in treatment include:

• Regular monitoring of TSH levels to adjust dosage as needed
• Maintaining a normal TSH range to improve quality of life and reduce symptoms
• Addressing related autoimmune conditions and ensuring adequate selenium intake
• Close monitoring and potential dose adjustments during pregnancy
• Considering combination therapy with T3 for patients with persistent symptoms despite normal TSH levels 1.

It is essential to prioritize the patient's quality of life and morbidity when making treatment decisions, as the evidence suggests that treatment of thyroid dysfunction based on risk level may not alter final health outcomes 1.

From the FDA Drug Label

As replacement or supplemental therapy in patients with hypothyroidism of any etiology, except transient hypothyroidism during the recovery phase of subacute thyroiditis As pituitary thyroid-stimulating hormone (TSH) suppressants, in the treatment or prevention of various types of euthyroid goiters, including thyroid nodules, subacute or chronic lymphocytic thyroiditis (Hashimoto's) and multinodular goiter Treatment of Hashimoto's can include Liothyronine (PO) as:

• Replacement or supplemental therapy in patients with hypothyroidism resulting from Hashimoto's
• A TSH suppressant to treat or prevent euthyroid goiters associated with Hashimoto's 2

From the Research

Treatment Options for Hashimoto's Thyroiditis

• The management of Hashitoxicosis is based on symptoms control, usually with β-blockers 3
• Euthyroidism requires periodical thyroid stimulating hormone measurements to assess for progression to hypothyroidism 3
• Hypothyroidism is treated with thyroid hormone replacement therapy, with the dose of levothyroxine (LT4) used for treatment based on the degree of preserved thyroid functionality and lean body mass, usually ranging from 1.4 to 1.8 mcg/kg/day 3
• Levothyroxine replacement may be needed long-term or lifelong in cases of overt or subclinical hypothyroidism, with a special focus on phases with additional demand like during pregnancy 4

Levothyroxine Therapy

• Levothyroxine sodium tablets have been shown to reverse Hashimoto thyroiditis-induced kidney injury, muscle injury, and lipid metabolism disorder in a case report 5
• The effectiveness of levothyroxine replacement therapy in severe complications of hypothyroidism, including treatment dosage and duration of complication recovery, has been explored 5
• Personalized thyroid hormone replacement therapy is necessary for hypothyroid patients, taking into account factors such as co-morbidities and pharmacogenomic and pharmacokinetic factors that may impact levothyroxine bioavailability 6

Additional Considerations

• Hashimoto's thyroiditis is associated with a higher risk of papillary thyroid cancer and thyroid lymphoma than the general population 3, 7
• The relationship between thyroid function, mental status, and psychiatric disorders is complex and requires further research 4
• Continuing research in biochemical, genetic, and neuroimaging fields is needed to clarify the mechanisms underlying the interactions between thyroid function and other systems 4