Subacute Thyroiditis Treatment & Management

  • Author: Mark R Allee, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Feb 7, 2007
 

Medical Care

  • Analgesia is the initial focus of therapy for the pain seen in subacute thyroiditis. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line agents used to treat the pain. Large dosages are typically needed. Most NSAIDs provide comparable efficacy of pain relief. Corticosteroids can be used with patients who fail NSAIDs or who have severe pain.
  • Corticosteroids are highly effective, and relief of pain is quick and dramatic. If pain and tenderness do not disappear within 72 hours of the start of therapy, the diagnosis of subacute thyroiditis should be questioned. Prednisone is administered in dosages of 40-60 mg per day. After 1-2 weeks, the steroids are tapered slowly. Symptoms of thyrotoxicosis are also alleviated with glucocorticoids.
  • Beta-blockers may be used if symptoms of adrenergic stimulation are troublesome. Propranolol has the theoretical advantage of inhibiting conversion of T4 to T3 at higher doses. Beta 1 selective agents (metoprolol or atenolol) have more convenient dosing and are better tolerated.
  • Thionamides are not indicated because the mechanism of thyrotoxicosis is leakage of hormone from damaged thyroid follicles not overproduction of the hormones.
  • When thyrotoxic symptoms are severe or if the patient cannot tolerate beta-blockers, ipodate or iopanoic acid can be used. They are potent blockers of conversion of T4 to T3. At a dose of 500 mg twice a day, these drugs rapidly normalize T3 levels and ameliorate the hyperthyroid symptoms.
  • The hypothyroid phase does not require treatment; however, if the patient is symptomatic, levothyroxine may be initiated with successful discontinuation after an arbitrary time of approximately 6 months.
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Consultations

Consultation with an endocrinologist may be beneficial.

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Contributor Information and Disclosures
Author

Mark R Allee, MD  Associate Professor, Department of Medicine, University of Oklahoma Health Sciences Center

Mark R Allee, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Mary Zoe Baker, MD  Professor, Department of Medicine, Section of Endocrinology, Metabolism and Hypertension, University of Oklahoma; Medical Director, University of Oklahoma Physicians, Medicine Specialty Clinic, General Medicine Clinic and Medicine Residents' Clinic

Mary Zoe Baker, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Chemical Society, and American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven R Gambert, MD, MACP  Chairman, Department of Medicine, Physician-in-Chief, Sinai Hospital of Baltimore; Professor of Medicine, Program Director, Internal Medicine Program, Johns Hopkins University School of Medicine

Steven R Gambert, MD, MACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American Geriatrics Society, Association of Professors of Medicine, Endocrine Society, and Gerontological Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Kent Wehmeier, MD  Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, St Louis University School of Medicine

Kent Wehmeier, MD is a member of the following medical societies: American Society of Hypertension, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

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