Are steroids used in the treatment of Hashimoto's thyroiditis?

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Last updated: October 20, 2026 • View editorial policy

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No, los esteroides NO se usan en el tratamiento estándar de la tiroiditis de Hashimoto

Los esteroides no están indicados para el tratamiento de la tiroiditis de Hashimoto (tiroiditis autoinmune crónica). El manejo estándar consiste únicamente en reemplazo con levotiroxina cuando hay hipotiroidismo, sin ningún papel para la terapia con corticoesteroides 1.

Distinción Crítica: Hashimoto vs. Otras Tiroiditis

Es fundamental diferenciar la tiroiditis de Hashimoto de otras formas de tiroiditis donde los esteroides SÍ tienen indicación:

Tiroiditis donde los esteroides ESTÁN indicados:

  • Tiroiditis subaguda (De Quervain): Los pacientes con síntomas moderados a severos deben tratarse con corticoesteroides (prednisona 40 mg/día por 2-4 semanas, seguido de reducción gradual por 2-3 meses) 1

  • Tiroiditis inducida por amiodarona tipo 2: Requiere prednisona 40 mg diarios como tratamiento de primera línea 1

  • Tiroiditis indolora/silente: Los esteroides se reservan SOLO para casos severos, no son tratamiento de rutina 1

Tiroiditis de Hashimoto: Sin indicación de esteroides

La tiroiditis de Hashimoto es una enfermedad autoinmune crónica caracterizada por anticuerpos antitiroideos (anti-TPO, anti-Tg) e infiltración linfocítica 2. El tratamiento se basa exclusivamente en:

  • Levotiroxina cuando hay hipotiroidismo clínico o subclínico (según criterios específicos)
  • Observación si el paciente está eutiroideo
  • Los betabloqueadores pueden usarse para síntomas de tirotoxicosis si ocurre una fase transitoria de destrucción glandular

Trampa Clínica Común

No confundir la encefalopatía de Hashimoto con la tiroiditis de Hashimoto: La encefalopatía de Hashimoto (encefalopatía sensible a esteroides) es una entidad neurológica rara asociada con anticuerpos antitiroideos que SÍ responde a esteroides o inmunoglobulina intravenosa 3. Sin embargo, esto es un síndrome neurológico separado, no el tratamiento de la enfermedad tiroidea en sí.

Evidencia Reciente sobre Síntomas Persistentes

Estudios recientes (2025-2026) muestran que muchos pacientes con Hashimoto permanecen sintomáticos a pesar de estar eutiroideos con levotiroxina 4, 5. Sin embargo, la evidencia NO respalda el uso de esteroides para estos síntomas persistentes. Las opciones emergentes incluyen:

  • Terapia combinada T4/T3 en pacientes seleccionados
  • Tiroidectomía total en casos refractarios severos
  • Suplementación con selenio o vitamina D como adyuvantes

Los esteroides no forman parte de ninguna de estas estrategias de manejo para Hashimoto 5.

References

1
Guideline

hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the american thyroid association and american association of clinical endocrinologists.

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologist, 2011

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