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

From the Guidelines

The primary treatment for Hashimoto's thyroiditis is levothyroxine (T4), a synthetic thyroid hormone replacement medication. Treatment is typically initiated when the condition progresses to hypothyroidism, indicated by elevated TSH levels 1. The starting dose is usually 1.6 mcg/kg/day (typically 50-125 mcg daily), taken on an empty stomach 30-60 minutes before breakfast or at bedtime, at least 4 hours after any interfering medications. Dose adjustments are made based on TSH levels checked every 6-8 weeks until stabilized, then annually. The goal is to maintain TSH within normal range (0.4-4.0 mIU/L) 1. Levothyroxine must be taken lifelong, as Hashimoto's causes permanent thyroid damage. Certain medications (calcium, iron supplements, antacids) and foods can interfere with absorption, so timing separation is important. Patients should be monitored for symptoms of under-treatment (fatigue, weight gain, cold intolerance) or over-treatment (palpitations, anxiety, insomnia). Treatment works by replacing the thyroid hormone that the damaged gland can no longer produce adequately, addressing the autoimmune-mediated destruction of thyroid tissue characteristic of Hashimoto's disease.

Some key points to consider:

• The most recent and highest quality study supporting this treatment approach is from 2015, as seen in the US Preventive Services Task Force recommendation statement 1.
• The treatment approach may vary depending on the individual patient's needs and response to treatment, but levothyroxine remains the primary treatment option.
• Other studies, such as those on immunosuppressive treatment regimens in autoimmune hepatitis, may provide additional insights into the management of autoimmune diseases, but are not directly applicable to Hashimoto's thyroiditis 1.
• The European Guidelines for Hidradenitis Suppurativa also emphasize the importance of evidence-based treatment, but are not relevant to the treatment of Hashimoto's thyroiditis 1.

Overall, the treatment of Hashimoto's thyroiditis with levothyroxine is a well-established approach, supported by multiple studies and guidelines, and should be prioritized in clinical practice to improve patient outcomes and quality of life.

From the FDA Drug Label

The general aim of therapy is to normalize the serum TSH level In adult patients with primary hypothyroidism, monitor serum TSH levels after an interval of 6 to 8 weeks after any change in dosage. In patients on a stable and appropriate replacement dosage, evaluate clinical and biochemical response every 6 to 12 months and whenever there is a change in the patient’s clinical status The recommended daily dosage of levothyroxine sodium tablets in pregnant patients is described in Table 3.

The treatment for Hashimoto's (Autoimmune) thyroiditis is levothyroxine sodium therapy, with the goal of normalizing serum TSH levels. The dosage is adjusted based on the patient's response, with monitoring of serum TSH and free-T4 levels. The specific dosage guidelines are provided in Table 3 for pregnant patients, and the dosage is adjusted to maintain serum TSH in the trimester-specific reference range. In adult patients, serum TSH levels are monitored after any change in dosage, and clinical and biochemical response is evaluated every 6 to 12 months 2.

From the Research

Treatment Options for Hashimoto's Thyroiditis

The treatment for Hashimoto's thyroiditis typically involves long-term levothyroxine (LT4) replacement therapy 3. However, some studies suggest that additional treatments may be beneficial in certain cases.

Levothyroxine Replacement Therapy

• Levothyroxine sodium oral solution can be effective in normalizing thyroid function in patients with Hashimoto's disease, particularly those with gastrointestinal disorders such as gastroparesis and small intestinal bacterial overgrowth (SIBO) 4.
• LT4 replacement therapy can help reduce thyroid-stimulating hormone (TSH) levels and alleviate symptoms of hypothyroidism.

Alternative and Adjunctive Therapies

• Photobiomodulation (PBM) has been shown to increase T3/T4 ratio and decrease thyroid peroxidase antibody (TPO Ab) levels, as well as reduce hormone replacement needs 3.
• Selenium supplementation may be beneficial in reducing TPOab titers and improving mood and well-being in patients with Hashimoto's thyroiditis 5.
• Prophylactic thyroid hormone replacement may be effective in reducing thyroid volume and improving clinical and laboratory findings in euthyroid patients with Hashimoto's thyroiditis 6.

Surgical Treatment

• Surgical treatment may be necessary in certain cases, such as:
  • Thyromegaly with compression symptoms
  • Nodular form of Hashimoto's thyroiditis with dominant thyroid nodules over 2 cm in size
  • Suspicion of neoplasm or unsightly neck appearance due to a large goiter 7
• Argon plasma resection (APR) is a new and promising technique for thyroid resection, particularly in patients with Hashimoto's thyroiditis 7.