What is the treatment for chronic lymphocytic thyroiditis?

Treatment for Chronic Lymphocytic Thyroiditis

The standard treatment for chronic lymphocytic thyroiditis (Hashimoto's thyroiditis) with hypothyroidism is levothyroxine sodium (LT4), with the addition of selenium providing enhanced benefits for thyroid antibody reduction, mood improvement, and inflammatory marker reduction. 1

Diagnosis and Evaluation

• Chronic lymphocytic thyroiditis (Hashimoto's thyroiditis) is confirmed through measurement of serum thyroid autoantibodies (thyroid peroxidase antibodies [TPOAb] and thyroglobulin antibodies [TGAb]) and thyroglobulin levels 2
• Initial evaluation should include assessment of thyroid function through total triiodothyronine (TT3), total thyroxine (TT4), and thyroid stimulating hormone (TSH) measurements 1
• Physical examination typically reveals goiter, though some patients may present with normal thyroid size 2, 3

Treatment Approach

For Patients with Hypothyroidism

• Levothyroxine sodium (LT4) is the primary treatment for chronic lymphocytic thyroiditis with hypothyroidism 1, 4
• Dosing should be adjusted based on TSH levels, with the goal of normalizing thyroid function 1
• Combination therapy of levothyroxine sodium with selenium has shown superior efficacy compared to levothyroxine alone, with higher total effective rates 1

Benefits of Combination Therapy (LT4 + Selenium)

• Combination therapy with LT4 and selenium provides greater reduction in thyroid autoantibodies (TGAb, TPOAb) compared to LT4 alone 1
• Patients receiving combination therapy show greater improvement in mood parameters as measured by Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores 1
• Inflammatory markers including IL-2 and TNF-α decrease more significantly with combination therapy, while anti-inflammatory IL-10 levels increase more substantially 1

Monitoring and Follow-up

• Regular monitoring of thyroid function (TT3, TT4, TSH) is essential to assess treatment efficacy 1, 5
• Periodic measurement of thyroid autoantibodies (TPOAb, TGAb) helps evaluate the immunological response to treatment 1
• Long-term follow-up is necessary as the disease course can change over time, with some patients experiencing spontaneous changes in thyroid function 4, 5

Special Considerations

• Pregnancy can significantly alter the course of chronic lymphocytic thyroiditis, sometimes converting hypothyroidism to hyperthyroidism in the postpartum period (postpartum thyroiditis) 4
• Goiter size may decrease with treatment in approximately 57% of patients, but 43% may show no reduction in goiter size despite adequate thyroid hormone replacement 5
• The natural history of the disease varies, with some untreated patients (38%) progressing to overt hypothyroidism over 10-20 years 5

Treatment Efficacy

• While thyroid hormone therapy effectively manages hypothyroidism, it does not necessarily alter the underlying autoimmune process in all patients 5
• Thyroid antibody titers decrease in only about 21% of patients over long-term follow-up, regardless of thyroid hormone treatment 5
• Histological changes in the thyroid gland may persist despite years of thyroid hormone therapy 5

Caveats and Pitfalls

• Thyroid hormone replacement should be initiated at lower doses in elderly patients or those with cardiovascular disease to avoid precipitating cardiac events 3
• Regular monitoring is essential as dosage requirements may change over time due to progression of the autoimmune process 5
• Patients should be educated about the chronic nature of the disease and the need for lifelong treatment in most cases 4, 3