What is the treatment for chronic thyroiditis, specifically Hashimoto's thyroiditis?

From the Guidelines

The primary treatment for Hashimoto's thyroiditis is thyroid hormone replacement therapy, typically with levothyroxine (T4). Treatment begins once hypothyroidism develops, with starting doses usually between 25-125 mcg daily depending on age, weight, and severity of hypothyroidism 1. The medication is taken once daily on an empty stomach, 30-60 minutes before breakfast or 3-4 hours after the last meal of the day. Dosage adjustments are made based on thyroid-stimulating hormone (TSH) levels, which should be checked 6-8 weeks after starting treatment or changing doses. The goal is to normalize TSH levels, typically between 0.5-2.5 mIU/L. Most patients require lifelong therapy. Certain medications and supplements (calcium, iron, antacids) can interfere with levothyroxine absorption, so they should be taken at least 4 hours apart. During pregnancy, dose requirements often increase by 25-50%, and more frequent monitoring is needed. Treatment is essential because Hashimoto's causes progressive destruction of the thyroid gland by autoimmune antibodies, leading to inadequate production of thyroid hormones which regulate metabolism, energy, and numerous bodily functions.

Some key points to consider:

• The optimal screening interval for thyroid dysfunction is unknown 1.
• The USPSTF found no direct evidence that treatment of thyroid dysfunction based on risk level alters final health outcomes 1.
• Long-term randomized, blinded, controlled trials of screening for thyroid dysfunction would provide the most direct evidence on any potential benefits of this widespread practice 1.

Overall, the treatment of Hashimoto's thyroiditis with levothyroxine is a well-established practice, and the goal of treatment is to normalize TSH levels and alleviate symptoms.

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

The treatment for chronic thyroiditis, specifically Hashimoto's thyroiditis, is replacement or supplemental therapy with thyroid hormone drugs, such as levothyroxine or liothyronine, to manage hypothyroidism.

• Levothyroxine is indicated for replacement therapy in primary, secondary, and tertiary congenital or acquired hypothyroidism 2.
• Liothyronine is indicated as replacement or supplemental therapy in patients with hypothyroidism, including those with Hashimoto's thyroiditis 3. Key points:
• Treatment aims to replace or supplement thyroid hormone deficiency.
• Liothyronine can be used as a TSH suppressant in the treatment of euthyroid goiters, including Hashimoto's thyroiditis.

From the Research

Treatment for Chronic Thyroiditis

• The treatment for chronic thyroiditis, specifically Hashimoto's thyroiditis, typically involves thyroid hormone replacement therapy 4, 5, 6.
• Levothyroxine (L-T4) is the standard treatment for hypothyroidism, which is often caused by Hashimoto's thyroiditis 5, 6.
• The dose of levothyroxine 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 5.
• In some cases, patients may not respond well to traditional levothyroxine tablets, and alternative formulations such as levothyroxine sodium oral solution may be used 4.
• Treatment with triiodothyronine (T3) is not typically recommended, except in pregnancy, where only levothyroxine is indicated 5, 6.

Management of Hashimoto's Thyroiditis

• The management of Hashimoto's thyroiditis involves controlling symptoms, monitoring thyroid function, and treating hypothyroidism with thyroid hormone replacement therapy 5, 7.
• Patients with Hashimoto's thyroiditis may experience cognitive impairments and decreased quality of life, despite treatment with levothyroxine 8.
• The presence of thyroid peroxidase antibodies (TPOAb) is associated with a higher risk of recurrent miscarriages and preterm birth in pregnant women 5.
• Hashimoto's thyroiditis is also associated with an increased risk of papillary thyroid cancer and thyroid lymphoma 5, 7.

Considerations for Treatment

• Patients with Hashimoto's thyroiditis may have comorbid gastrointestinal disorders, such as gastroparesis and small intestinal bacterial overgrowth (SIBO), which can affect the absorption of levothyroxine 4.
• The treatment of Hashimoto's thyroiditis should take into account the individual patient's needs and circumstances, including their age, sex, and any comorbid conditions 6, 7.