What is the treatment for thyroiditis?

From the Guidelines

The treatment for thyroiditis should be guided by the severity of symptoms and the specific type of thyroiditis, with a focus on managing symptoms and restoring normal thyroid hormone levels, as evidenced by the most recent guidelines 1. When considering treatment options, it's essential to differentiate between various types of thyroiditis, including subacute, Hashimoto's, postpartum, silent, acute suppurative, and radiation-induced thyroiditis.

• For painful subacute thyroiditis, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) are typically used first, with prednisone (20-40mg daily, tapered over 2-4 weeks) added for severe cases.
• Hashimoto's thyroiditis usually requires lifelong levothyroxine replacement therapy, starting at 1.6 mcg/kg/day and adjusted based on TSH levels, as recommended by older guidelines 1.
• Postpartum thyroiditis often resolves without treatment, but temporary levothyroxine may be needed during the hypothyroid phase.
• Silent thyroiditis typically requires only symptomatic treatment with beta-blockers like propranolol (10-40mg three times daily) during the hyperthyroid phase, with close monitoring of thyroid function every 2-3 weeks after diagnosis to catch the transition to hypothyroidism 1.
• Acute suppurative thyroiditis needs antibiotics targeting the causative organism, often including coverage for Staphylococcus aureus.
• Radiation-induced thyroiditis is managed symptomatically. Regular monitoring of thyroid function is essential for all types, as thyroiditis can progress through different phases of thyroid function, and treatment should be adjusted accordingly, with consideration of holding immune checkpoint inhibitor therapy in cases of moderate to severe symptoms 1.

From the Research

Treatment Options for Thyroiditis

• The treatment for thyroiditis focuses on relieving pain and controlling the inflammatory process 2, 3, 4, 5.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids are commonly used to treat thyroid pain and inflammation 2, 3, 4, 5.
• Beta blockers can be used to treat adrenergic symptoms in the hyperthyroid phase of thyroiditis 3.
• Thyroid hormone therapy may be necessary for patients with hypothyroidism or permanent hypothyroidism 3, 6.

Steroid Treatment

• Steroid treatment has been shown to be effective in achieving symptomatic remission in patients with subacute thyroiditis 2, 4.
• Steroid treatment may be considered especially in patients with positive thyroid peroxidase antibody (anti-TPO) and high-level acute phase reactants 2.
• 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 5.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) Treatment

• NSAID treatment is not as effective as steroid treatment in early clinical remission 2.
• NSAID treatment may be associated with a higher risk of permanent hypothyroidism compared to steroid treatment 2.
• NSAIDs can be used to treat thyroid pain and inflammation, but may not be sufficient for patients with severe symptoms 3, 4.

Thyroid Hormone Therapy

• Thyroid hormone therapy is necessary for patients with hypothyroidism or permanent hypothyroidism 3, 6.
• The goal of thyroid hormone therapy is to personalize treatment for each patient, taking into account their individual needs and response to treatment 6.