From the Guidelines
Surgery is not typically the first-line treatment for chronic thyroiditis (Hashimoto's thyroiditis), but it may be considered in specific situations. Most patients with chronic thyroiditis are managed with thyroid hormone replacement therapy, typically levothyroxine (starting at 1.6 mcg/kg/day), which addresses the hypothyroidism that commonly develops.
Key Considerations for Surgery
- The thyroid gland is significantly enlarged causing compressive symptoms like difficulty swallowing or breathing
- Cosmetic concerns from a very large goiter
- Suspicion of thyroid cancer that requires tissue examination In these cases, a total or partial thyroidectomy may be performed. After thyroid surgery, patients will likely need lifelong thyroid hormone replacement therapy.
Decision Making for Surgery
The decision for surgery should be made after careful consideration of:
- Symptoms
- Thyroid function tests (TSH, free T4)
- Ultrasound findings
- Discussion with an endocrinologist and surgeon as the autoimmune nature of chronic thyroiditis means surgery doesn't address the underlying immune dysfunction but rather manages its complications 1.
From the Research
Surgical Options for Chronic Thyroiditis (Hashimoto's Thyroiditis)
Surgery is considered an option for treating chronic thyroiditis (Hashimoto's thyroiditis) in certain cases. The following points highlight the indications and outcomes of surgical intervention:
- Surgical intervention is considered for patients with painful Hashimoto's thyroiditis who do not respond to medical therapy, as seen in a study of seven patients who underwent thyroidectomy 2.
- Surgery can also be an effective therapy for patients with a huge goiter that has not shrunk in response to levothyroxine (L-T4) therapy, as reported in a study of 13 patients with Hashimoto's thyroiditis 3.
- Indications for surgery in patients with goiter and background Hashimoto's thyroiditis include nodular goiter, associated malignancy, persistent goiter, pressure symptoms, and painful thyroiditis, as found in a retrospective study of 34 cases 4.
- A review article discussing surgical decision-making in thyroiditis highlights the importance of considering factors such as indications for surgery, improvement of local compressor symptoms, risk of thyroid cancer, intraoperative difficulty, and postoperative complications 5.
- In general, surgery is rarely indicated for thyroiditis, and treatment is usually medical, focusing on symptoms and thyroid function, as noted in a review of thyroiditis evaluation and treatment 6.
Key Indications for Surgery
The following are key indications for surgery in patients with chronic thyroiditis (Hashimoto's thyroiditis):
- Painful thyroiditis not responding to medical therapy
- Huge goiter that has not shrunk in response to L-T4 therapy
- Nodular goiter
- Associated malignancy
- Persistent goiter
- Pressure symptoms
- Painful thyroiditis
Outcomes of Surgical Intervention
The outcomes of surgical intervention for chronic thyroiditis (Hashimoto's thyroiditis) include: