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Question:

Treatment of subacute thyroiditis and autoimmune thyroiditis

Dear Ask The Doctor:
I have Subcutaneous Thyroiditis again and the last time I went to a Thyroid "Specialist" he said there was nothing they could do for the condition and it would soon go away. He also said it could reoccur at any time. Isn't there anything they can do for this condition? It is very uncomfortable, painful, and the fatigue, shortness of breath, insomnia, constipation etc. are all troublesome. I have many autoimmune diseases and didn't need this one. Is there no cure or medication that can be given to help with this condition?


Answer:

The term thyroiditis includes a wide variety of disorders characterized by some form of inflammation of the thyroid gland. It may be caused by: infection, viral or bacterial; auto-immune disease where the immune system attacks the thyroid gland as it recognizes the gland as foreign tissue; drugs (amiodarone); post partum; fibrous disease (Riedels thyroiditis); subacute granulomatus thyroiditis (de Quervains thyroiditis); and chronic lymphocytic disease (Hashimotos thyroiditis). The treatment of thyroiditis is related to the underlying cause. If your thyroiditis is accompanied by a painful and tender thyroid gland it may be due to subacute granulomatous thyroiditis rather than autoimmune disease. Subacute thyroiditis is presumed to be caused by a viral infection or a postviral inflammatory process and a previous history of autoimmunity may be linked. The difference between subacute thyroiditis and autoimmune thyroiditis, is that subacute thyroiditis is self-limited and often runs a distinct course, unlike autoimmune thyroid disease. In subacute thyroiditis there is a distinctive pattern with an initial overactive phase which lasts only until the stores of T4 and T3 are depleted, usually two to six weeks, then the underactive phase (which rarely can be permanent) and complete recovery may take up to 8 or 9 months. Treatment of subacute thyroiditis is directed at providing relief for thyroid pain and tenderness with antiinflammatory therapy with either a nonsteroidal antiinflammatory drug (NSAID) or prednisone. Prednisone therapy should result in pain relief in one to two days; if not, the diagnosis should be questioned. Treatment of autoimmune thyroiditis is thyroid hormone replacement with levothyroxine sodium, usually for life. I advise consulting your endocrinologist to discuss which treatment option would be beneficial in your case.



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