From the Guidelines
Chronic thyroiditis, also known as Hashimoto's thyroiditis, is an autoimmune disorder where the immune system attacks the thyroid gland, leading to inflammation and eventual hypothyroidism, and treatment typically involves daily oral levothyroxine (synthetic T4 hormone) at doses starting at 1.6 mcg/kg body weight, adjusted based on thyroid function tests, as recommended by the most recent guidelines 1.
Key Considerations
- The principal treatment for hypothyroidism is oral T4 monotherapy (levothyroxine sodium) 1.
- Initial TSH levels should be checked after 6-8 weeks of therapy, with the goal of maintaining TSH within normal range (typically 0.5-4.5 mIU/L) 1.
- Patients should take levothyroxine on an empty stomach, 30-60 minutes before breakfast or 3-4 hours after the last meal of the day, avoiding calcium, iron supplements, and certain foods that can interfere with absorption.
- Treatment is typically lifelong as the condition causes progressive thyroid damage.
- Some patients may experience periods of transient hyperthyroidism before developing permanent hypothyroidism.
- The autoimmune nature of the disease means patients have higher risk of developing other autoimmune conditions like celiac disease, pernicious anemia, or vitiligo, so awareness of symptoms related to these conditions is important.
Management of Hypothyroidism
- For grade 1 hypothyroidism (TSH < 4.5 and < 10 mIU/L and asymptomatic), continue ICPi with monitoring of TSH every 4-6 weeks as part of routine care 1.
- For grade 2 hypothyroidism (moderate symptoms, able to perform ADL, TSH persistently > 10 mIU/L), may continue or hold ICPi until symptoms resolve to baseline, and consider endocrine consultation for unusual clinical presentations, concern for central hypothyroidism, or difficulty titrating hormone therapy 1.
- For grade 3-4 hypothyroidism (severe symptoms, medically significant or life-threatening consequences, unable to perform ADL), hold ICPi until symptoms resolve to baseline with appropriate supplementation, and endocrine consultation to assist with rapid hormone replacement 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Definition and Forms of Thyroiditis
- Thyroiditis is a general term for inflammation of the thyroid gland, with common forms including Hashimoto, postpartum, and subacute thyroiditis 2.
- These forms of thyroiditis often result in a triphasic disease pattern of thyroid dysfunction, starting with hyperthyroidism, followed by hypothyroidism, and eventually restoration of normal thyroid function 2.
Treatment and Management
- Hashimoto thyroiditis is an autoimmune disorder that may present with or without signs or symptoms of hypothyroidism, and is often treated with lifelong thyroid hormone therapy 2.
- Treatment of subacute thyroiditis focuses on symptoms, with beta blockers used to treat adrenergic symptoms in the hyperthyroid phase, and nonsteroidal anti-inflammatory drugs and corticosteroids used to treat thyroid pain 2.
- Thyroid hormone replacement therapy is essential in patients with hypothyroidism, with levothyroxine being the standard treatment 3, 4, 5.
Personalization of Thyroid Hormone Replacement Therapy
- Personalization of thyroid hormone replacement therapy is necessary to ensure optimal treatment outcomes in hypothyroid patients 3.
- Factors such as sex, age, body weight, and lean body mass can influence l-T4 requirements, and failure to achieve optimal serum TSH levels can have adverse consequences 4.
- Combined therapy with T3 and T4 may be beneficial in some patients with hypothyroidism, particularly those with polymorphisms in the DIO2 gene 6.