Conditions with Similar Symptoms
View Conditions
  Drug Monographs
Antibiotics
Aspirin
Beta-Adrenergic Blockers
Corticosteroids
Propranolol
Thyroid Product
  Herb Monographs
Ginkgo Biloba
Horsetail
Lemon Balm
Passionflower
Turmeric
  Supplement Monographs
Bromelain
Calcium
Flaxseed Oil
Iodine
Magnesium
Quercetin
Selenium
Tyrosine
Vitamin A (Retinol)
Vitamin B1 (Thiamine)
Vitamin B12 (Cobalamin)
Vitamin B2 (Riboflavin)
Vitamin B3 (Niacin)
Vitamin B5 (Pantothenic Acid)
Vitamin B6 (Pyridoxine)
Vitamin B9 (Folic Acid)
Vitamin C (Ascorbic Acid)
Vitamin E
Zinc
  Learn More About
Acupuncture
Homeopathy
Nutrition
Western Herbalism
Look Up > Conditions > Thyroiditis
Thyroiditis
Overview
Definition
Etiology
Risk Factors
Signs and Symptoms
Differential Diagnosis
Diagnosis
Physical Examination
Laboratory Tests
Pathology/Pathophysiology
Imaging
Treatment Options
Treatment Strategy
Drug Therapies
Complementary and Alternative Therapies
Patient Monitoring
Other Considerations
Complications/Sequelae
Prognosis
Pregnancy
References

Overview
Definition

Thyroiditis is an inflammatory condition of the thyroid gland. Patient may present with clinical features of hyperthyroidism or hypothyroidism. There are several types, both common (Hashimoto's, subacute, silent) and rare (suppurative, Riedel's). These vary by cause, course, and histopathology:

  • Hashimoto's (struma lymphomatosa, lymphadenoid goiter, chronic lymphocytic thyroiditis): an autoimmune disorder closely related to Graves' disease, with a familial tendency; it is the most common cause of hypothyroidism in patients not previously treated for overactive thyroid.
  • Subacute (de Quervain's thyroiditis, granulomatous thyroiditis, giant cell thyroiditis): self-limited inflammation; a prodromal upper respiratory infection is common.
  • Silent (acute lymphocytic thyroiditis): related to Hashimoto's; self-limited, usually occurring in young to middle-aged women; hyper- or hypothyroidism may spontaneously resolve.
  • Suppurative: rare disorder usually occurring in the course of a systemic infection.
  • Riedel's (chronic fibrous thyroiditis, Riedel's struma, wood thyroiditis, ligneous thyroiditis, invasive thyroiditis): rarest form; found most frequently among middle-aged women; may cause both hypothyroidism and hypoparathyroidism.

Etiology

Hashimoto's thyroiditis is an immune disorder, with lymphocytes gradually replacing thyroid tissue; gland enlarges, and hypothyroidism slowly develops. Subacute is most likely a viral infection, with leaked thyroid hormone causing transient thyrotoxicosis, followed by hypothyroidism. The trigger for silent thyroiditis is unknown, but may involve an autoimmune mechanism. The suppurative form is caused by pyogenic organisms. Riedel's thyroiditis is caused by multifocal systemic fibrosis syndrome.


Risk Factors
  • Prodromal upper respiratory tract infection (subacute)
  • Pregnancy
  • Graves' disease (Hashimoto's)
  • Positive family history or preceding autoimmune diseases or conditions

Signs and Symptoms

Hashimoto's:

  • Firm, symmetrically enlarged, lobulated gland not tender on palpation; few pressure symptoms
  • Progressive worsening of hypothyroid symptoms—cool, dry skin, slow pulse rate (60 bpm), swelling around eyes, hoarseness, slow reflexes

Subacute:

  • Acute, painful enlargement of thyroid; pain possibly radiating to ears or jaw
  • Dysphagia
  • Malaise and low-grade fever

Silent:

  • Mild hyperthyroid symptoms—rapid heartbeat, slight nervousness, hyperactivity, weight loss (5 to 10 lbs.), increased perspiration
  • Thyroid moderately enlarged and firm but not tender or painful

Suppurative:

  • Severe pain, tenderness, redness, fluctuation in thyroid area

Riedel's:

  • Thyroid asymmetrically enlarged, stony, adheres to neck structures
  • Signs of compression and invasion—dysphagia, dyspnea, hoarseness

Differential Diagnosis
  • Graves' disease
  • Goiter
  • Carcinoma
  • Thyrotoxicosis
  • Sore throat
  • Dental problems
  • Ear infection

Diagnosis
Physical Examination

With Hashimoto's, the gland is firm, symmetrically enlarged, not tender on palpation, with few pressure symptoms. With subacute, the gland is acutely painful, with pain radiating to the ears and jaw. If no pain is present, silent form is likely. Suppurative produces severe pain and redness. With Riedel's, the enlarged gland is asymmetric and hard.


Laboratory Tests
  • TSH and serum T4 and T3 levels: Hashimoto's—T4, 5 mcg/100 ml, TSH >5.0 mcU/ml; subacute—suppressed TSH (<0.1 mcU/ml), elevated serum or free T4; silent—increased T4 and decreased TSH
  • Radioiodine uptake: very low to zero in hyperthyroid phase of subacute; high in chronic forms; low in Riedel's
  • Thyroid antibody test: high titers in Hashimoto's; possible in other types
  • Erythrocyte sedimentation rate: elevated in subacute; markedly elevated in silent
  • Biopsy: only if antibodies not detected and no apparent cause for symptoms; see giant cells in silent thyroiditis

Pathology/Pathophysiology

Lymphocyte infiltration, fibrosis, atrophy (lymphocyte), mononuclear cell infiltrate, giant cells (granulomatous)


Imaging

Thyroid radioiodine scan (granulomatous)


Treatment Options
Treatment Strategy

The course of each type of thyroiditis generally involves three phases: hyperthyroid phase, hypothyroid phase, and return to euthyroid status. Treatment is symptomatic and individualized to type and phase.


Drug Therapies

Hashimoto's:

  • Levothyroxine: 0.1 to 0.15 mg daily if hypothyroidism or large goiter present

Subacute:

  • Aspirin: two tablets (325 mg) three to four times daily as needed to relieve pain and inflammation
  • Steroids (such as prednisone or dexamethasone): at lowest dose that relieves pain; gives relief in 24 hours, but continue four to six weeks after pain is gone; severe cases only
  • Propranolol: 10 to 40 mg every six hours for thyrotoxic symptoms
  • Thyroxine: 0.05 to 0.1 mg/daily for hypothyroidism symptoms

Silent:

  • Short-term beta-blockers: as needed for hyperthyroid symptoms
  • Levothyroxine: as needed for hypothyroid symptoms

Suppurative:

  • Antibiotics and surgical drainage: as needed for marked fluctuation

Riedel's:

  • Partial thyroidectomy: to relieve pressure

Complementary and Alternative Therapies

Concurrent therapy with medications may be necessary.


Nutrition
  • Foods that depress the thyroid are broccoli, cabbage, brussels sprouts, cauliflower, kale, spinach, turnips, soy, beans, and mustard greens. These foods should be included in the diet for hyperthyroid conditions and avoided for hypothryroid conditions.
  • Avoid refined foods, sugar, dairy products, wheat, caffeine, and alcohol.
  • Essential fatty acids are anti-inflammatory and necessary for hormone production. Take 1,000 to 1,500 mg flaxseed oil tid.
  • Calcium (1,000 mg/day) and magnesium (200 to 600 mg/day) are cofactors for many metabolic processes.

For hyperthyroid conditions:

  • Bromelain (250 to 500 mg tid between meals) is a proteolytic enzyme that reduces inflammation.
  • Vitamin C (1,000 mg tid to qid) supports immune function and decreases inflammation.

For hypothyroid conditions:

  • Vitamin C (1,000 mg tid to qid), vitamin A (10,000 to 25,000 IU/day), B-complex (50 to 100 mg/day), selenium (200 mcg/day), iodine (300 mcg/day), vitamin E (400 IU/day), and zinc (30 mg/day) are necessary for thyroid hormone production.
  • L-tyrosine (100 mg bid) also supports normal thyroid function. May exacerbate hypertension.

Herbs

Ascertain a diagnosis before pursuing treatment. Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink two to four cups/day. Tinctures may be used singly or in combination as noted.

For hyperthyroid conditions:

  • Bugleweed (Lycopus virginica) and lemon balm (Melissa officinalis) help to normalize the overactive thyroid.
  • Motherwort (Leonurus cardiaca) relieves heart palpitations and passionflower (Passiflora incarnata) reduces anxiety. Combine two parts of bugleweed with one part each of lemon balm, motherwort, and passionflower in a tincture, 30 to 60 drops tid to qid.
  • Quercetin (250 to 500 mg tid) is an anti-inflammatory.
  • Turmeric (Curcuma longa) potentiates bromelain and should be taken between meals, 500 mg tid.
  • Ginkgo biloba 80 to 120 mg bid.

For hypothyroid conditions:

  • A combination that would support thyroid function includes herbs rich in minerals. Combine the following for a tea (3 to 4 cups/day) or tincture (20 to 30 drops tid). Horsetail (Equisetum arvense), oatstraw (Avena sativa), alfalfa (Medicago sativa), gotu kola (Centella asiatica), and bladderwrack (Fucus vesiculosus)

Homeopathy

An experienced homeopath should assess individual constitutional types and severity of disease to select the correct remedy and potency.


Physical Medicine

For hyperthyroid conditions: ice packs to the throat for inflammation.

For hypothyroid conditions: contrast hydrotherapy to the neck and throat may stimulate thyroid function. Alternating hot and cold applications brings nutrients to the site and diffuses metabolic waste from inflammation. The overall effect is decreased inflammation, pain relief, and enhanced healing. Alternate three minutes hot with one minute cold and repeat three times. This is one set. Do two to three sets/day. In addition, exercise sensitizes thyroid gland to hormones and improves its function.


Acupuncture

Acupuncture may be helpful in correcting hormonal imbalances and addressing underlying deficiencies and excesses involved in thyroiditis.


Patient Monitoring
  • Hashimoto's is associated with other autoimmune diseases (Addison's disease, pernicious anemia, etc.), so monitor the patient for these.
  • Because Hashimoto's can progress to hypothyroidism, schedule yearly checkups and begin treatment promptly.
  • Repeat thyroid function tests 3 to 12 months in lymphocytic thyroiditis, and every three to six weeks in granulomatous thyroiditis, until euthyroid.

Other Considerations
Complications/Sequelae
  • High doses of glucocorticoids can cause stomach ulcers, bone loss.
  • Hypothyroidism may develop after silent or Hashimoto's thyroiditis.

Prognosis

Some degree of compromise or disability is expected for 6 to 12 months: hyperthyroid phase, 1 to 3 months; hypothyroid phase, 3 to 6 months, then gradual return to euthyroid.


Pregnancy

Thyroid testing during pregnancy may have variable and unreliable results. Mild pathology may not be detected until after pregnancy.


References

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:432.

The Burton Goldberg Group, compilers. Alternative Medicine: The Definitive Guide. Tiburon, Calif: Future Medicine Publishing Inc; 1997.

Ferri FF. Ferri's Clinical Advisor: Instant Diagnosis and Treatment. St Louis, Mo: Mosby-Year Book;1999.

Hoffman D. The New Holistic Herbal. New York, NY: Barnes & Noble Books; 1995:95.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing; 1998:386-390.

Noble J, ed. Textbook of Primary Care Medicine. 2nd ed. St Louis, Mo: Mosby-Year Book; 1996.

Tierney LM Jr, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis and Treatment. Norwalk, Conn: Appleton & Lange; 1994.


Copyright © 2000 Integrative Medicine Communications

This publication contains information relating to general principles of medical care that should not in any event be construed as specific instructions for individual patients. The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application, use, or misuse of any of the information contained herein, including any injury and/or damage to any person or property as a matter of product liability, negligence, or otherwise. No warranty, expressed or implied, is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. The reader is advised to check product information (including package inserts) for changes and new information regarding dosage, precautions, warnings, interactions, and contraindications before administering any drug, herb, or supplement discussed herein.