What is the treatment for autoimmune thyroiditis?

From the Guidelines

The primary treatment for autoimmune thyroiditis (Hashimoto's thyroiditis) is thyroid hormone replacement therapy, typically with levothyroxine (T4), as indicated by the USPSTF recommendation statement 1.

Treatment Overview

The treatment is indicated when the condition leads to hypothyroidism, which is common as the immune attack progressively damages the thyroid gland.

• The starting dose of levothyroxine is usually 1.6 mcg/kg body weight daily, taken on an empty stomach 30-60 minutes before breakfast or 3-4 hours after the last meal of the day.
• Medication should be taken at the same time each day for consistent absorption.
• Dose adjustments are made based on thyroid-stimulating hormone (TSH) levels, which should be checked 6-8 weeks after starting therapy or changing doses.
• The goal is to normalize TSH levels, typically to 0.5-2.5 mIU/L, as suggested by the USPSTF recommendation statement 1.

Monitoring and Adjustments

Treatment is generally lifelong since the autoimmune damage to the thyroid is permanent.

• Regular monitoring with blood tests every 6-12 months is necessary to ensure proper dosing.
• Levothyroxine works by replacing the natural thyroid hormone that the damaged gland can no longer produce in sufficient quantities, thereby restoring normal metabolism and relieving symptoms such as fatigue, weight gain, cold intolerance, and depression.

Important Considerations

Although detection and treatment of abnormal TSH levels (with or without abnormal T4 levels) in asymptomatic persons is common practice, evidence that this clinical approach improves important health outcomes is lacking, as noted in the research needs and gaps section of the USPSTF recommendation statement 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.
• Serum TSH levels that define eligibility for enrollment, particularly based on age-specific ranges, are needed.
• Important clinical outcomes include cardiovascular- and cancer-related morbidity and mortality, as well as falls, fractures, functional status, and quality of life.

From the FDA Drug Label

Levothyroxine sodium is used for the following indications: Hypothyroidism - As replacement or supplemental therapy in congenital or acquired hypothyroidism of any etiology, except transient hypothyroidism during the recovery phase of subacute thyroiditis Pituitary TSH Suppression - In the treatment or prevention of various types of euthyroid goiters, including thyroid nodules, subacute or chronic Iymphocytic thyroiditis (Hashimoto's thyroiditis)

The treatment for autoimmune thyroiditis (also known as Hashimoto's thyroiditis) is levothyroxine sodium as replacement or supplemental therapy for hypothyroidism.

• Key points:
  • Levothyroxine sodium is used to treat hypothyroidism of any etiology, including primary, secondary, and tertiary hypothyroidism.
  • It is also used for pituitary TSH suppression in the treatment or prevention of euthyroid goiters, including thyroid nodules and subacute or chronic lymphocytic thyroiditis (Hashimoto's thyroiditis) 2
  • Patients with autoimmune thyroiditis may require careful dosage titration to avoid over- or under-treatment, and should be monitored for potential effects on bone mineral density, cardiovascular function, and other medical conditions 2

From the Research

Treatment for Autoimmune Thyroiditis

The treatment for autoimmune thyroiditis typically involves managing hypothyroidism, which is a common consequence of the condition.

• Levothyroxine is the standard treatment for hypothyroidism, as it is safe, inexpensive, and effective in restoring thyroid function tests to within the reference range and improving symptoms in the majority of patients 3.
• The required dose of levothyroxine can vary depending on the patient's age and the severity of hypothyroidism. For example, a study found that juvenile patients with autoimmune thyroiditis require significantly lower doses of levothyroxine than patients with congenital hypothyroidism, with a mean dose of 1.5 ± 0.5 μg/kg per day 4.
• In some cases, patients may not respond to high peroral doses of thyroxine, which can be due to poor compliance or malabsorption. In such cases, intravenous administration of levothyroxine may be effective 5.
• Some patients may experience persistent symptoms despite levothyroxine treatment, leading to the use of alternative treatments such as liothyronine or desiccated thyroid extract. However, the effectiveness and safety of these treatments are still debated 3.
• Beta blockers can be used to treat symptoms in the initial hyperthyroid phase of postpartum thyroiditis, while levothyroxine can be used in the subsequent hypothyroid phase 6.

Special Considerations

• The diagnosis and management of hypothyroidism can be complex, and individualized reference intervals based on factors such as age, sex, and pregnancy may be necessary 3.
• Ongoing symptoms despite levothyroxine treatment can be a challenge, and further research is needed to determine the best treatment strategies for these patients 3.
• Autoimmune thyroiditis can have a significant impact on quality of life, and treatment should aim to not only restore thyroid function but also improve overall well-being 7.