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). This medication is taken daily to replace the thyroid hormone that the damaged thyroid can no longer produce adequately. The starting dose is usually based on weight (approximately 1.6 mcg/kg/day), but older adults or those with heart disease may start at lower doses (25-50 mcg/day) 1. Dosage is adjusted every 6-8 weeks based on TSH levels until optimal levels are achieved, typically aiming for a TSH between 0.5-2.5 mIU/L. Levothyroxine should be taken on an empty stomach, 30-60 minutes before breakfast or 3-4 hours after the last meal of the day, and separated from calcium, iron supplements, and certain medications that can interfere with absorption. Once the correct dose is established, patients typically need annual TSH monitoring. Treatment is usually lifelong since Hashimoto's causes permanent thyroid damage. Proper treatment restores normal metabolism, alleviates symptoms like fatigue, weight gain, and cold intolerance, and prevents complications of hypothyroidism such as cardiovascular disease and dyslipidemia. Some patients may benefit from selenium supplementation (200 mcg daily) to reduce antibody levels and inflammation, though this remains somewhat controversial 1.

Key considerations in the treatment of Hashimoto's thyroiditis include:

• Monitoring TSH levels regularly to adjust the dose of levothyroxine as needed
• Avoiding interference with levothyroxine absorption from other medications or supplements
• Considering selenium supplementation for its potential anti-inflammatory effects
• Recognizing that treatment is usually lifelong due to the permanent nature of the thyroid damage caused by Hashimoto's thyroiditis 1.

It's also important to note that while the USPSTF found no direct evidence that treatment of thyroid dysfunction based on risk level alters final health outcomes, the principal treatment for hypothyroidism is oral T4 monotherapy (levothyroxine sodium) 1. Hyperthyroidism is treated with antithyroid medications or nonreversible thyroid ablation therapy, although definitive data are lacking for these treatments 1.

Overall, the goal of treatment for Hashimoto's thyroiditis is to restore normal thyroid function and prevent long-term complications, with a focus on individualized care based on the patient's specific needs and health status.

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

Hypothyroidism Levothyroxine sodium tablets are indicated in adult and pediatric patients, including neonates, as a replacement therapy in primary (thyroidal), secondary (pituitary), and tertiary (hypothalamic) congenital or acquired hypothyroidism

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

• Liothyronine can be used as replacement or supplemental therapy in patients with hypothyroidism, including those with Hashimoto's thyroiditis 2.
• Levothyroxine can be used as replacement therapy in adult and pediatric patients with primary, secondary, or tertiary congenital or acquired hypothyroidism, which may result from Hashimoto's thyroiditis 3.

From the Research

Treatment for Chronic Thyroiditis

• The treatment for chronic thyroiditis, specifically Hashimoto's thyroiditis, typically involves thyroid hormone replacement therapy with levothyroxine (L-T4) 4, 5, 6, 7.
• 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.
• Levothyroxine monotherapy is the standard treatment for hypothyroidism, and it is safe and inexpensive, restores thyroid function tests to within the reference range, and improves symptoms in the majority of patients 8.
• In some cases, patients may not respond well to levothyroxine treatment due to various factors such as co-morbidities, lack of vitamin and trace elements, pharmacogenomic and pharmacokinetic factors, thyroid hormone resistance, and transport- or conversion disorder 7.

Management of Hashitoxicosis

• The management of Hashitoxicosis is based on symptoms control, usually with β-blockers 5.
• Euthyroidism requires periodical thyroid-stimulating hormone measurements to assess for progression to hypothyroidism 5.
• Hypothyroidism is treated with thyroid hormone replacement therapy, and the treatment is usually lifelong 5, 7.

Special Considerations

• In pregnancy, only levothyroxine is indicated, as triiodothyronine (T3) does not sufficiently cross the fetal blood-brain barrier 5.
• Patients with Hashimoto's disease may have food and medication sensitivities, as well as comorbid gastrointestinal (GI) disorders that can affect levothyroxine absorption 4.
• Malabsorption of L-T4 is often seen in patients with Hashimoto's disease-related hypothyroidism and comorbid GI conditions, such as gastroparesis and small intestinal bacterial overgrowth (SIBO) 4.