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Thyroiditis Treatment & Management

  • Author: Robert P Hoffman, MD; Chief Editor: Stephen Kemp, MD, PhD  more...
 
Updated: Sep 03, 2015
 

Medical Care

Acute thyroiditis

  • Acute thyroiditis requires immediate parenteral antibiotic therapy before abscess formation begins. For initial antibiotic therapy, administer penicillin or ampicillin to cover gram-positive cocci and the anaerobes that are the usual causes of the disease.
  • In patients who are allergic to penicillin, cephalosporins are appropriate.
  • Patients with acute thyroiditis may require inpatient care to complete 10-14 days of antibiotics.

Subacute thyroiditis

  • Subacute thyroiditis is self-limiting; therefore, the goals of treatment are to relieve discomfort and to control the abnormal thyroid function. The discomfort can usually be relieved with low-dose aspirin (divided every 4-6 h). In the rare cases that aspirin does not relieve the discomfort, administer prednisone for 1 week and then taper.
  • Propranolol can be used to reduce signs and symptoms of hyperthyroidism.
  • Low-dose levothyroxine may be necessary in some patients who develop hypothyroidism.

Chronic autoimmune thyroiditis

  • Treatment for chronic autoimmune thyroiditis depends on the results of the thyroid function tests. Patients with overt hypothyroidism who have high thyroid-stimulating hormone (TSH) and low free T4 levels require treatment with levothyroxine. The dose is age dependent. TSH levels should be monitored and the dose should be adjusted to maintain levels within the reference range.
  • The treatment of subclinical hypothyroidism in patients with elevated TSH and normal free T4 levels is controversial. These children may enter a remission phase and may not have permanent hypothyroidism. This appears to be a minority of subjects. One study found that 4 of 14 subjects had normalization of TSH after a follow-up of 3-12 years. Most pediatric endocrinologists recommend treatment of subclinical hypothyroidism during childhood to ensure normal growth and development. If thyroxine administration may not be permanently required, treatment may be stopped once the patient has completed pubertal development, and thyroid function then can be reassessed. Guidelines for the diagnosis and management of subclinical thyroid disease have been established.
  • The use of thyroxine treatment in patients with a goiter due to autoimmune thyroiditis who have normal TSH and free T4 levels is even more controversial. Some studies have suggested that treatment may decrease gland size,[8, 9] but other studies suggest that reduction in gland size is likely only in children with initially elevated TSH levels.[4]
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Surgical Care

In acute thyroiditis, surgery may be necessary to drain the abscess and to correct the developmental abnormality responsible for the condition.

The surgical service consulted depends on the institution and the physician who has the most experience with thyroid surgery. Options include the following:

  • Pediatric surgery
  • Otolaryngology
  • A specialized endocrine surgery service
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Consultations

Acute thyroiditis: Consulting with a pediatric infectious disease specialist may be useful for selecting appropriate antibiotic therapy.

Subacute and chronic thyroiditis: Consulting with a pediatric endocrinologist should be considered in treating children with these disorders. This is particularly true if the child has experienced poor growth possibly due to hypothyroidism, has symptoms of overt hyperthyroidism, or has a discrete thyroid nodule.

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Diet

No dietary limitations are necessary.

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Activity

Children with overt hyperthyroidism or hypothyroidism have poor exercise tolerance. These children usually limit their own activity. As treatment progresses and thyroid function levels return to normal, their exercise tolerance should increase.

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Long-Term Monitoring

Subacute thyroiditis

  • This is a self-limiting disease that may last 2-7 months.
  • During this time, monitor thyroid function and adjust medications as needed.

Chronic autoimmune thyroiditis

  • Outpatient care involves monitoring thyroid function tests. Patients with normal thyroid function test results should be examined every 6 months to ensure that they do not develop hypothyroidism. After a year, these visits may be annual.
  • Children who require thyroxine therapy should undergo thyroid function tests every 3-12 months, depending on age. More frequent testing is required in younger children. Thyroid-stimulating hormone (TSH) and free T4 levels should be checked 1 month after any change in dosage.
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Contributor Information and Disclosures
Author

Robert P Hoffman, MD Professor and Program Director, Department of Pediatrics, Ohio State University College of Medicine; Pediatric Endocrinologist, Division of Pediatric, Endocrinology, Diabetes, and Metabolism, Nationwide Children's Hospital

Robert P Hoffman, MD is a member of the following medical societies: American College of Pediatricians, American Diabetes Association, American Pediatric Society, Christian Medical and Dental Associations, Endocrine Society, Midwest Society for Pediatric Research, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Lynne Lipton Levitsky, MD Chief, Pediatric Endocrine Unit, Massachusetts General Hospital; Associate Professor of Pediatrics, Harvard Medical School

Lynne Lipton Levitsky, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Diabetes Association, American Pediatric Society, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research

Disclosure: Received grant/research funds from Eli Lilly for pi; Received grant/research funds from NovoNordisk for pi; Received consulting fee from NovoNordisk for consulting; Partner received consulting fee from Onyx Heart Valve for consulting.

Chief Editor

Stephen Kemp, MD, PhD Former Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital

Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Arlan L Rosenbloom, MD Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida College of Medicine; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology

Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, Florida Chapter of The American Academy of Pediatrics, Florida Pediatric Society, International Society for Pediatric and Adolescent Diabetes

Disclosure: Nothing to disclose.

References
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  4. Fava A, Oliverio R, Giuliano S, Parlato G, Michniewicz A, Indrieri A, et al. Clinical Evolution of Autoimmune Thyroiditis in Children and Adolescents. Thyroid. 2009 Feb 18. [Medline].

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  8. Karges B, Muche R, Knerr I, et al. Levothyroxine in euthyroid autoimmune thyroiditis and type 1 diabetes: a randomized, controlled trial. J Clin Endocrinol Metab. 2007 May. 92(5):1647-52. [Medline].

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Three multinuclear, giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid; from a patient with thyrotoxicosis from lymphocytic or subacute granulomatous thyroiditis.
 
 
 
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