Thyroiditis Treatment & Management

  • Author: Robert P Hoffman, MD; Chief Editor: Stephen Kemp, MD, PhD   more...
 
Updated: Nov 16, 2011
 

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.
  • 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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Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Robert P Hoffman, MD  Associate Professor of Pediatrics, Department of Pediatrics, Ohio State University College of Medicine

Robert P Hoffman, MD is a member of the following medical societies: American Diabetes Association, American Pediatric Society, Christian Medical & Dental Society, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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, Florida Pediatric Society, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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, and Society for Pediatric Research

Disclosure: Pfizer Grant/research funds P.I.; Tercica Grant/research funds Other; Eli Lily Grant/research funds PI; NovoNordisk Grant/research funds PI

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD  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, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

References

  1. Iacovelli P, Sinagra JL, Vidolin AP, et al. Relevance of thyroiditis and of other autoimmune diseases in children with vitiligo. Dermatology. 2005;210(1):26-30. [Medline].

  2. Fisher DA, Greueters, A. Thyroid disorders in childhood and adolesence. In: Sperling MA. Pediatric Endocrinology,. 3rd ed. Philadelphia, PA: Sunders Elevier; 2008:227-53.

  3. Demirbilek H, Kandemir N, Gonc EN, Ozon A, Alikasifoglu A, Yordam N. Hashimoto's thyroiditis in children and adolescents: a retrospective study on clinical, epidemiological and laboratory properties of the disease. J Pediatr Endocrinol Metab. Nov 2007;20(11):1199-205. [Medline].

  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. Feb 18 2009;[Medline].

  5. Sattar N, Lazare F, Kacer M, Aguayo-Figueroa L, Desikan V, Garcia M, et al. Celiac disease in children, adolescents, and young adults with autoimmune thyroid disease. J Pediatr. Feb 2011;158(2):272-5.e1. [Medline].

  6. de Vries L, Bulvik S, Phillip M. Chronic autoimmune thyroiditis in children and adolescents: at presentation and during long-term follow-up. Arch Dis Child. Jan 2009;94(1):33-7. [Medline].

  7. Dobert N, Balzer K, Diener J, Wegscheider K, Vaupel R, Grunwald F. Thyroid sonomorphology, thyroid peroxidase antibodies and thyroid function: new epidemiological data in unselected German employees. Nuklearmedizin. 2008;47(5):194-9. [Medline].

  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. May 2007;92(5):1647-52. [Medline].

  9. Svensson J, Ericsson UB, Nilsson P, et al. Levothyroxine treatment reduces thyroid size in children and adolescents with chronic autoimmune thyroiditis. J Clin Endocrinol Metab. May 2006;91(5):1729-34. [Medline].

  10. Bauer DC, Brown AN. Sensitive thyrotropin and free thyroxine testing in outpatients. Are both necessary?. Arch Intern Med. Nov 11 1996;156(20):2333-7. [Medline].

  11. Bogazzi F, Bartalena L, Tomisti L, et al. Glucocorticoid response in amiodarone-induced thyrotoxicosis resulting from destructive thyroiditis is predicted by thyroid volume and serum free thyroid hormone concentrations. J Clin Endocrinol Metab. Feb 2007;92(2):556-62. [Medline].

  12. Dayan CM, Daniels GH. Chronic autoimmune thyroiditis. N Engl J Med. Jul 11 1996;335(2):99-107. [Medline].

  13. de Kerdanet M, Lucas J, Lemee F, Lecornu M. Turner's syndrome with X-isochromosome and Hashimoto's thyroiditis. Clin Endocrinol (Oxf). Nov 1994;41(5):673-6. [Medline].

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  16. Mandac JC, Chaudhry S, Sherman KE, Tomer Y. The clinical and physiological spectrum of interferon-alpha induced thyroiditis: toward a new classification. Hepatology. Apr 2006;43(4):661-72. [Medline].

  17. McCanlies E, O'Leary LA, Foley TP, et al. Hashimoto's thyroiditis and insulin-dependent diabetes mellitus: differences among individuals with and without abnormal thyroid function. J Clin Endocrinol Metab. May 1998;83(5):1548-51. [Medline]. [Full Text].

  18. Nordyke RA, Gilbert FI Jr, Miyamoto LA, Fleury KA. The superiority of antimicrosomal over antithyroglobulin antibodies for detecting Hashimoto's thyroiditis. Arch Intern Med. Apr 12 1993;153(7):862-5. [Medline].

  19. Pearce EN, Bogazzi F, Martino E, et al. The prevalence of elevated serum C-reactive protein levels in inflammatory and noninflammatory thyroid disease. Thyroid. Jul 2003;13(7):643-8. [Medline].

  20. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. Jun 26 2003;348(26):2646-55. [Medline].

  21. Rother KI, Zimmerman D, Schwenk WF. Effect of thyroid hormone treatment on thyromegaly in children and adolescents with Hashimoto disease. J Pediatr. Apr 1994;124(4):599-601. [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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