Subacute Thyroiditis Medication
- Author: Stephanie L Lee, MD, PhD; Chief Editor: George T Griffing, MD more...
Medication Summary
Medical treatment for subacute thyroiditis is supportive in general. Thyrotoxicosis can be extreme but temporary (eg, 6-8 wk). The subsequent hypothyroid phase is usually mild and lasts 2-4 months. Therapy is directed toward reducing the signs and symptoms of the hyperthyroidism with beta blockers or iodine agents. Pain is treated with nonsteroidal anti-inflammatory agents (NSAIDs). Rarely, high-dose steroids and narcotic analgesic agents are used for extremely painful or recurrent life-threatening hyperthyroidism.
Nonsteroidal anti-inflammatory drugs
Class Summary
Anti-inflammatory agents are administered to patients with painful subacute thyroiditis. Patients should avoid high-dose aspirin because it can increase free thyroid hormone levels by displacing thyroid hormone from its protein binding sites. Narcotic analgesics can be administered if the pain is extreme and prevents oral hydration. Rarely, high-dose steroids (eg, prednisone 40-60 mg PO qd for 4-6 wk) may be used to decrease the pain, if necessary.
Ibuprofen (Advil, Motrin)
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Naproxen (Aleve, Naprosyn, Naprelan)
For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in a decrease of prostaglandin synthesis.
Indomethacin (Indocin)
Rapidly absorbed. Metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation. Inhibits prostaglandin synthesis.
Iodinated contrast agents
Class Summary
High iodine levels inhibit the peripheral conversion of T4 to T3. The most effective agents are the iodinated contrast agents, but high levels of iodine provided by SSKI (saturated solution of potassium iodide, 2 drops in full glass of water PO tid) can be substituted.
Iopanoic acid (Telepaque)
PO contrast agent for rapid and significant inhibition of peripheral conversion of T4 to T3. Inorganic iodide released also blocks release of thyroid hormones. Reduction in conversion of T4 to T3 can greatly reduce T3 levels and thyrotoxic symptoms over a few d.
Ipodate (Oragrafin)
One of the most effective inhibitors of deiodinase, which converts T4 to the more biologically active T3. Reduction in conversion of T4 to T3 can greatly reduce T3 levels and thyrotoxic symptoms.
Thyroid hormones
Class Summary
Most patients with subacute thyroiditis experience a hypothyroid phase following thyrotoxicosis. Asymptomatic patients do not need to be treated if TSH is mildly elevated (< 15 µIU/mL), but they should be tested q4wk to confirm that hypothyroidism is not worsening or becoming permanent. Thyroid hormone is generally administered (usually 50 mcg/d) to normalize TSH. After 6 months, when 90-95% of patients have returned to normal thyroid function, thyroid hormone is discontinued and the TSH level is checked 4 wk after discontinuation of therapy. If the TSH level is within the reference range, no further treatment is necessary. If the TSH level is elevated, the patient has permanent hypothyroidism, and therapy should be continued indefinitely.
Levothyroxine (Levoxyl, Synthroid)
In active form, influences growth and maturation of tissues. Involved in normal growth, metabolism, and development. L-thyroxine supplementation only during the hypothyroid phase of subacute thyroiditis. The goal of therapy is a TSH level within the reference range for 6 mo; then discontinue therapy. TSH should be checked 4 wk later, and, if TSH is elevated, L-thyroxine therapy must be reinstituted and continued indefinitely.
Beta-adrenergic blocking agents
Class Summary
Beta blockers reduce many of the symptoms of thyrotoxicosis, including tachycardia, tremor, and anxiety. Propranolol is usually recommended because of CNS penetration, but some patients prefer the longer-acting beta blockers.
Propranolol (Inderal)
DOC in treating cardiac arrhythmia resulting from hyperthyroidism. Controls cardiac and psychomotor manifestations within minutes.
Atenolol (Tenormin)
Selectively blocks beta1-receptors with little or no effect on beta2 types.
Corticosteroids
Class Summary
If thyroid pain is extreme, high-dose steroids rapidly reduce thyroid hormone levels and swelling. Generally, therapy must be continued for 4-6 wk before tapering.
Prednisone (Deltasone, Orasone, Sterapred)
May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
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