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 inflammation and restoring normal thyroid hormone levels, as recommended by the most recent guidelines from the Journal of Clinical Oncology 1.
Treatment Approach
The approach to treating thyroiditis can be broken down based on the severity of symptoms:
- For asymptomatic or mild symptoms (G1), treatment can continue with immune checkpoint inhibitors (ICPi), and beta-blockers such as atenolol or propranolol can be used for symptomatic relief, with close monitoring of thyroid function every 2-3 weeks to catch the transition to hypothyroidism 1.
- For moderate symptoms (G2), consideration should be given to holding ICPi until symptoms return to baseline, with endocrine consultation and the use of beta-blockers for symptomatic relief, as well as hydration and supportive care 1.
- For severe symptoms (G3-4), ICPi should be held until symptoms resolve to baseline with appropriate therapy, including endocrine consultation, beta-blockers, hydration, and supportive care, with consideration of hospitalization in severe cases for additional medical therapies including steroids, SSKI, or thionamide (methimazole or propylthiouracil) and possible surgery 1.
Key Considerations
- Regular thyroid function monitoring is essential as the condition may progress from hyperthyroidism to hypothyroidism.
- Treatment aims to manage inflammation and restore normal thyroid hormone levels.
- The use of thyroxine replacement therapy may be necessary for hypothyroid phases, and beta-blockers can be used for hyperthyroid symptoms.
- For painful thyroiditis, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be used, with prednisone added for severe cases, as suggested by previous guidelines 1.
Monitoring and Management
- Thyroid function should be monitored closely, with TSH and FT4 used for case detection in symptomatic patients, and T3 helpful in highly symptomatic patients with minimal FT4 elevations 1.
- Consideration should be given to TSH receptor antibody testing if there are clinical features and suspicion of Graves’ disease.
- The management of thyroiditis should be individualized based on the specific type and symptoms present, with a focus on minimizing morbidity, mortality, and improving quality of life.
From the FDA Drug Label
Levothyroxine sodium is used for the following indications: ... subacute or chronic Iymphocytic thyroiditis (Hashimoto's thyroiditis) 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 thyroiditis, specifically subacute or chronic lymphocytic thyroiditis (Hashimoto's thyroiditis), is levothyroxine sodium.
- Levothyroxine sodium is used as replacement or supplemental therapy.
- It is also used in the treatment or prevention of euthyroid goiters associated with thyroiditis. 2
From the Research
Treatment Options for Thyroiditis
- The treatment for thyroiditis depends on the type and severity of the condition, as well as the patient's symptoms and overall health 3, 4, 5, 6, 7.
- For subacute thyroiditis, treatment typically focuses on relieving pain and reducing inflammation, with options including nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids 3, 4, 6, 7.
- In some cases, beta blockers may be used to treat symptoms of hyperthyroidism, while levothyroxine may be used to treat hypothyroidism 4, 5, 7.
- For Hashimoto thyroiditis, treatment typically involves lifelong thyroid hormone therapy with levothyroxine 4, 5, 7.
- Postpartum thyroiditis is often transient and may not require treatment, but in some cases, beta blockers or levothyroxine may be used to manage symptoms 4, 7.
Medication Options
- NSAIDs, such as ibuprofen, may be used to relieve pain and reduce inflammation in subacute thyroiditis 3, 6, 7.
- Corticosteroids, such as prednisolone, may be used to treat subacute thyroiditis, with a typical starting dose of 20-40 mg per day 3, 6.
- Levothyroxine is commonly used to treat hypothyroidism in Hashimoto thyroiditis and other forms of thyroiditis 4, 5, 7.
- Beta blockers, such as propranolol, may be used to treat symptoms of hyperthyroidism in subacute thyroiditis and other forms of thyroiditis 4, 7.