From the Guidelines
Treatment for thyroiditis should be guided by the severity of symptoms and the specific type of thyroiditis, with a focus on managing symptoms, replacing deficient hormones, and monitoring thyroid function. The management of thyroiditis can be complex, and the approach may vary depending on the underlying cause and severity of the condition.
- For asymptomatic or mild symptoms (G1), treatment may involve continuing immune checkpoint inhibitor (ICPi) therapy, using beta-blockers like atenolol or propranolol for symptomatic relief, and closely monitoring thyroid function every 2-3 weeks after diagnosis 1.
- For moderate symptoms (G2), consideration should be given to holding ICPi therapy until symptoms return to baseline, with endocrine consultation and beta-blocker use for symptomatic relief, as well as hydration and supportive care 1.
- For severe symptoms (G3-4), ICPi therapy should be held until symptoms resolve to baseline with appropriate therapy, with endocrine consultation, beta-blocker use, hydration, and supportive care, and consideration of hospitalization in severe cases 1. In terms of specific treatments,
- beta-blockers like propranolol (10-40mg three times daily) may be used for symptomatic relief of hyperthyroid symptoms 1.
- thyroxine replacement therapy may be necessary for hypothyroidism, starting at a dose of 0.5-1.5 μg/kg/day, with adjustments based on TSH levels 1. Regular monitoring of thyroid function is essential, with TSH and free T4 tests every 4-8 weeks initially, then every 6-12 months once stable 1. It is also important to consider the potential for transition to hypothyroidism, particularly in cases of transient subacute thyroiditis, and to treat accordingly with thyroxine replacement therapy 1.
From the Research
Treatment Options for Thyroiditis
The treatment for thyroiditis depends on the type and severity of the condition. The following are some of the treatment options:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen to relieve pain and reduce inflammation 2, 3, 4
- Corticosteroids such as prednisolone to reduce inflammation and swelling 2, 3, 5, 6
- Beta blockers to treat adrenergic symptoms in the hyperthyroid phase 4
- Thyroid hormone therapy for patients with Hashimoto thyroiditis and overt hypothyroidism 5, 4
- Antibiotics or antifungals for acute thyroiditis of infectious origin 5
Subacute Thyroiditis Treatment
Subacute thyroiditis is a self-limited inflammatory disease characterized by anterior neck pain. The treatment should focus on symptoms, including:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation 2, 3, 4
- Corticosteroids such as prednisolone to reduce inflammation and swelling 2, 3, 6
- Low dose prednisolone (15-20 mg/day) has been shown to be effective in treating subacute thyroiditis 3, 6
Hashimoto Thyroiditis Treatment
Hashimoto thyroiditis is an autoimmune disorder that presents with or without signs or symptoms of hypothyroidism. The treatment includes:
- Thyroid hormone therapy for patients with overt hypothyroidism 5, 4
- Monitoring of thyroid function and adjustment of therapy as needed 5, 4
Postpartum Thyroiditis Treatment
Postpartum thyroiditis occurs within one year of delivery, miscarriage, or medical abortion. The treatment includes: