Click here for Frequently Asked Questions on Thyroiditis.
The thyroid gland usually contains an abundance of thyroid hormone that is stored in follicles and released when needed. Inflammation of the thyroid, termed thyroiditis, may result in uncontrolled release of thyroid hormone from the inflamed gland, leading to hyperthyroidism. The inflammation may be silent and non-painful, and patients may be unaware that the thyroid gland is affected by the inflammatory process. Thyroiditis also commonly occurs after pregnancy, and hence may be referred to in this instance as ‘postpartum thyroiditis’.
Alternatively, thyroid inflammation may be quite severe and painful (subacute thyroiditis), producing local neck discomfort, neck tenderness, difficulty with swallowing and symptoms of systemic inflammation, including fatigue, fever, loss of appetite and weight loss.
With both types of thyroiditis, the inflammation can produce some degree of thyroid enlargement, which can be particularly prominent with subacute thyroiditis.
If enough thyroid hormone is released from the inflamed thyroid gland, mild to severe hyperthyroidism may develop, that can last for weeks to months. Following the resolution of thyroiditis, the thyroid gland often begins to function normally again, and no further treatment may be necessary. If the inflammation has produced significant permanent damage to the thyroid, the gland may not be able to function normally after the inflammation has subsided, and hypothyroidism may ensue.
A common form of thyroid inflammation is frequently detected in women after childbirth, and hence is referred to as Postpartum thyroiditis.
Treatment of thyroiditis may not be required if the symptoms are mild and well tolerated. Alternatively, the use of beta blockers such as propranolol or atenolol may produce significant symptomatic relief by reducing symptoms such as fast heart beats, anxiety, shakiness, and increased sweating. In more severe cases, treatment with antithyroid drugs such as PTU may be indicated for several weeks. Rarely, if the thyroiditis is particularly severe and debilitating, glucocorticoid therapy (such as prednisone) may be indicated.
Some patients with thyroiditis may present with fluctuating symptoms of neck tenderness, thyroid enlargement, awareness of their neck, and fatigue. In these instances, a short therapeutic trial of a non-steroidal anti-inflammatory agent may be indicated to see if patients experience symptomatic relief.
I have had repeated episodes of thyroiditis, that are interfering with my life. Can anything be done about this?
In many instances, the thyroid gland will settle down and episodes will become less frequent. In some cases, it may be worthwhile to take L-thyroxine as a trial to determine whether "putting the thyroid to sleep" will reduce the frequency and severity of recurrent thyroiditis. Alternatively, treatment with a short course of anti-inflammatory medication may be helpful. Rarely, some patients with recurrent and disabling episodes of thyroiditis may elect to remove their thyroid, either surgically, or using radioactive iodine ablation, but it is usually not necessary to select this option in the vast majority of patients. See Autoimmune thyroid disease accompanied by recurring episodes of painful thyroid ameliorated by thyroidectomy. J Endocrinol Invest. 2002 Dec;25(11):996-1000 and Painful Hashimoto's Thyroiditis as an Indication for Thyroidectomy: Clinical Characteristics and Outcome in Seven Patients. J Clin Endocrinol Metab. 2003 Jun;88(6):2667-72.
I had thyroiditis and I am better now, but my antibodies are still positive. What does this mean?
Patients with autoimmune thyroid diseases such as Hashimoto's thyroiditis and Grave's disease will commonly have elevated levels of thyroid antibodies in the blood. These antibodies can be measured, usually as antithyroglobulin or antimicrosomal antibodies, in blood tests. Nevertheless, the presence of the antibodies in the blood does not necessarily signify active thyroid disease, nor does it accurately predict that the thyroid disease will recur. Furthermore, the antibodies may persist in your blood and remain elevated for decades, yet have no major clinical significance and may not correlate at all with what is happening to your thyroid. Hence, it is generally not helpful to frequently repeat the thyroid antibody test.
I have a small thyroid gland, mild hyperthyroidism, and my physician is not sure if I have thyroiditis or Grave's disease. Is there a way to find out?
Classically, an iodine uptake test will show low iodine uptake in the setting of thyroiditis, and elevated iodine uptake in active Graves' disease. If disease symptoms are mild, it is not unusual to defer carrying out such a test, and simply observe the patient. Thyroiditis will often improve without treatment over weeks to months, whereas Graves' disease is much less likely to improve spontaneously. In some settings, such as the recovery phase of thyroiditis, an iodine uptake may be elevated, and it may be difficult to distinguish Graves' disease from thyroiditis using the iodine uptake result alone.What is my risk of developing permanent hypothyroidism after a bout of subacute thyroiditis?
The answer depends on how severe your thyroid inflammation was, but in a Mayo Clinic study, about 15% of patients developed permanent hypothyroidism requiring thyroxine therapy. See Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted county, Minnesota, study. J Clin Endocrinol Metab. 2003 May;88(5):2100-5.
Is subacute thyroiditis more common in some families?
Although there is little information about this issue, and most cases
are sporadic, familial clustering of subacute thyroiditis and association
with specific genetic inherited markers, has been described Familial
occurrence of painful subacute thyroiditis associated with human leukocyte
Med. 2007 Mar 22; [Epub ahead of print]