From the Guidelines
Thyroiditis treatment depends on the specific type and severity of the condition, with the primary goal of managing symptoms and restoring normal thyroid hormone levels. For painful subacute thyroiditis, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) are typically the first-line treatment, as recommended by various studies 1. If pain persists, prednisone (20-40mg daily, tapered over 2-4 weeks) may be prescribed, as suggested by some guidelines 1. Hashimoto's thyroiditis causing hypothyroidism requires levothyroxine replacement therapy, usually starting at 1.6 mcg/kg/day (typically 75-125 mcg daily for adults), adjusted based on TSH levels every 6-8 weeks until stable, according to recent studies 1. Postpartum thyroiditis often resolves without treatment, but temporary levothyroxine may be needed during the hypothyroid phase, as noted in some research 1. For hyperthyroid symptoms in any type of thyroiditis, beta-blockers like propranolol (10-40mg three to four times daily) can provide relief, as recommended by various guidelines 1. Regular thyroid function monitoring is essential during treatment, as thyroiditis can progress through different phases of thyroid function, and treatment should be adjusted accordingly, as suggested by recent studies 1. Some key points to consider in the treatment of thyroiditis include:
- The use of NSAIDs and prednisone for painful subacute thyroiditis
- The importance of levothyroxine replacement therapy for Hashimoto's thyroiditis causing hypothyroidism
- The potential need for temporary levothyroxine therapy in postpartum thyroiditis
- The use of beta-blockers for hyperthyroid symptoms
- The need for regular thyroid function monitoring to adjust treatment as necessary. The most recent and highest quality study, published in 2021, provides guidance on the management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy, including the treatment of thyroiditis 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
Hypothyroidism Levothyroxine sodium tablets are indicated in adult and pediatric patients, including neonates, as a replacement therapy in primary (thyroidal), secondary (pituitary), and tertiary (hypothalamic) congenital or acquired hypothyroidism ... • Levothyroxine sodium tablets are not indicated for treatment of hypothyroidism during the recovery phase of subacute thyroiditis.
The treatment for Thyroiditis (inflammation of the thyroid gland) is not directly addressed by levothyroxine sodium tablets, except that it is stated that levothyroxine sodium tablets are not indicated for treatment of hypothyroidism during the recovery phase of subacute thyroiditis 2.
From the Research
Treatment Options for Thyroiditis
The treatment for thyroiditis, an inflammation of the thyroid gland, varies depending on the specific type and symptoms.
- For Hashimoto thyroiditis, treatment with levothyroxine is recommended to ameliorate hypothyroidism and may reduce goiter size 3, 4, 5.
- In the hyperthyroid phase of thyroiditis, beta blockers can be used to treat adrenergic symptoms 3, 4.
- For subacute thyroiditis, treatment is focused on relieving symptoms, with nonsteroidal anti-inflammatory drugs and corticosteroids indicated for thyroid pain 3, 4, 6.
- In cases of painful Hashimoto thyroiditis, low-dose oral prednisone, intrathyroidal corticosteroid injection, or total thyroidectomy may be considered for pain control 7.
- Surveillance and clinical follow-up are recommended to monitor for changes in thyroid function in all cases of thyroiditis 3.
Medications Used
The following medications may be used in the treatment of thyroiditis:
- Levothyroxine for hypothyroidism 3, 4, 5
- Beta blockers for hyperthyroid symptoms 3, 4
- Nonsteroidal anti-inflammatory drugs for thyroid pain 3, 4, 6
- Corticosteroids for thyroid pain and inflammation 3, 6, 7
- Acetylsalicylic acid for relief of thyroid pain 4
Special Considerations
Certain drugs, such as amiodarone, immune checkpoint inhibitors, interleukin-2, interferon-alfa, lithium, and tyrosine kinase inhibitors, may induce thyroiditis 3, 6, 5.
- Patients with a history of thyroid disease or those taking these medications should be closely monitored for changes in thyroid function.