From the Guidelines
The treatment of hyperthyroidism related to thyroiditis primarily focuses on symptom management as the condition is often self-limiting, with beta-blockers such as propranolol or atenolol being the mainstay of treatment to control symptoms like palpitations, tremors, and anxiety during the hyperthyroid phase. According to the most recent and highest quality study 1, the management of thyrotoxicosis due to thyroiditis involves checking TSH every 4-6 weeks as part of routine clinical monitoring for asymptomatic patients on ICPi therapy, and using TSH and FT4 for case detection in symptomatic patients.
Key Considerations
- Beta-blockers like atenolol or propranolol are used for symptomatic relief in patients with mild symptoms (G1) and can continue ICPi therapy with close monitoring of thyroid function every 2-3 weeks after diagnosis 1.
- For patients with moderate symptoms (G2), consideration should be given to holding ICPi until symptoms return to baseline, with beta-blockers and hydration and supportive care as needed, and endocrine consultation for additional workup and possible medical thyroid suppression 1.
- In severe cases (G3-4), ICPi should be held until symptoms resolve to baseline with appropriate therapy, with endocrine consultation, beta-blockers, hydration, and supportive care, and consideration of hospitalization for inpatient endocrine consultation and possible additional medical therapies including steroids, SSKI, or thionamide (methimazole or propylthiouracil) and possible surgery 1.
Monitoring and Follow-Up
- Regular thyroid function testing every 4-6 weeks during the course of illness is recommended to guide treatment adjustments, as many patients will progress to a hypothyroid phase within 1-3 months, which may require temporary levothyroxine supplementation (typically 50-100mcg daily) 1.
- Most cases of thyroiditis-related hyperthyroidism resolve completely within 3-6 months, though some patients (approximately 5-10%) may develop permanent hypothyroidism requiring long-term thyroid hormone replacement 1.
From the FDA Drug Label
In patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter for whom surgery or radioactive iodine therapy is not an appropriate treatment option. The FDA drug label does not answer the question about the treatment of hyperthyroidism related to thyroiditis, as the provided text only mentions Graves' disease and toxic multinodular goiter, but not thyroiditis.
From the Research
Treatment of Hyperthyroidism Related to Thyroiditis
- The treatment of hyperthyroidism related to thyroiditis typically involves symptomatic relief, as the condition is often transient 2, 3, 4.
- Beta blockers can be used to treat adrenergic symptoms such as anxiety, insomnia, and palpitations in the hyperthyroid phase of thyroiditis 2, 5.
- Nonsteroidal anti-inflammatory drugs and corticosteroids may be used to treat thyroid pain associated with subacute thyroiditis 2.
- In some cases, treatment with antithyroid drugs, radioactive iodine ablation, or surgery may be necessary, but this is typically reserved for cases of Graves' disease, toxic multinodular goiter, or toxic adenoma 3, 6, 4.
- The choice of treatment depends on the underlying diagnosis, the presence of contraindications, the severity of hyperthyroidism, and the patient's preference 4.
Management of Thyroiditis
- Surveillance and clinical follow-up are recommended to monitor for changes in thyroid function in patients with thyroiditis 2.
- Treatment of thyroiditis should focus on symptoms, and patients may require treatment for hypothyroidism if it develops 2.
- Certain drugs, such as amiodarone, immune checkpoint inhibitors, interleukin-2, interferon-alfa, lithium, and tyrosine kinase inhibitors, may induce thyroiditis, and patients taking these medications should be monitored for thyroid dysfunction 2.
Role of Beta Blockers
- Beta blockers, such as propranolol, metoprolol, and atenolol, can be used to control symptoms of hyperthyroidism, including nervousness, tremor, and tachycardia 5.
- Beta blockers may also reduce the frequency of paralysis in patients with thyrotoxic periodic paralysis and improve sweating and myopathy 5.
- The use of beta blockers can provide symptomatic relief while awaiting definitive diagnosis or treatment, and can be used as an adjunct to antithyroid drugs or radioactive iodine 5.