Antibiotics
Class Summary
These agents are used to treat acute suppurative thyroiditis. First-line antibiotic choices to treat acute thyroiditis include parenteral penicillin or ampicillin. These drugs cover most of the gram-positive cocci and anaerobes that cause the disease.
Penicillin G (Pfizerpen)
Antibiotic with activity against gram-positive, some gram-negative, and some anaerobic bacteria. Penicillin binds to PBPs, inhibiting bacterial cell wall growth.
Ampicillin (Principen)
Penicillin antibiotic with activity against gram-positive and some gram-negative bacteria. Binds to PBPs, inhibiting bacterial cell wall growth.
Anti-inflammatory drugs
Class Summary
These drugs are used to decrease discomfort in patients with subacute thyroiditis.
Aspirin (Anacin, Bayer)
Most patients respond well to aspirin as a first-line therapy. Treats mild to moderate pain. Inhibits prostaglandin synthesis, which prevents formation of platelet-aggregating thromboxane A2.
Prednisone (Sterapred)
Used when aspirin is ineffective in controlling discomfort in patients with subacute thyroiditis. May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
Beta-adrenergic blocking agents
Class Summary
Many signs and symptoms of hyperthyroidism are due to increased beta-adrenergic sensitivity. In particular, these include the hemodynamic abnormalities of tachycardia and hypertension. Beta-adrenergic blockade can reduce many of these symptoms. These agents are the DOC in treating cardiac arrhythmias that result from hyperthyroidism. These agents control cardiac and psychomotor manifestations within minutes.
Propranolol (Inderal)
Can be immediately initiated in patients with hyperthyroidism due to either subacute thyroiditis or autoimmune thyroiditis. Because of the self-limiting nature of these situations, they may be the only drugs needed.
Hormones
Class Summary
These agents are used to treat hypothyroidism due to autoimmune thyroiditis. Use thyroid-stimulating hormone (TSH) levels to monitor dose and keep them within the reference range.
Levothyroxine (Levothroid, Levoxyl, Synthroid)
Levothyroxine is a synthetic form of thyroxine involved in normal growth, metabolism, and development.
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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.
