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
- 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
- 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
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.
- Prodromal upper respiratory tract infection (subacute)
- Graves' disease (Hashimoto's)
- Positive family history or preceding autoimmune diseases or
|Signs and Symptoms|
- 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
- Acute, painful enlargement of thyroid; pain possibly radiating to
ears or jaw
- Malaise and low-grade fever
- Mild hyperthyroid symptoms—rapid heartbeat,
slight nervousness, hyperactivity, weight loss (5 to 10 lbs.), increased
- Thyroid moderately enlarged and firm but not tender or
- Severe pain, tenderness, redness, fluctuation in thyroid
- Thyroid asymmetrically enlarged, stony, adheres to neck
- Signs of compression and invasion—dysphagia,
- Graves' disease
- Sore throat
- Dental problems
- Ear infection
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.
- 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
- 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
Lymphocyte infiltration, fibrosis, atrophy (lymphocyte), mononuclear cell
infiltrate, giant cells (granulomatous)
Thyroid radioiodine scan (granulomatous)
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.
- Levothyroxine: 0.1 to 0.15 mg daily if hypothyroidism or large goiter
- 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
- Thyroxine: 0.05 to 0.1 mg/daily for hypothyroidism
- Short-term beta-blockers: as needed for hyperthyroid
- Levothyroxine: as needed for hypothyroid
- Antibiotics and surgical drainage: as needed for marked
- Partial thyroidectomy: to relieve
|Complementary and Alternative
Concurrent therapy with medications may be necessary.
- 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
- 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
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
- L-tyrosine (100 mg bid) also supports normal thyroid function. May
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
An experienced homeopath should assess individual constitutional types and
severity of disease to select the correct remedy and potency.
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 may be helpful in correcting hormonal imbalances and addressing
underlying deficiencies and excesses involved in
- 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
- High doses of glucocorticoids can cause stomach ulcers, bone
- Hypothyroidism may develop after silent or Hashimoto's
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.
Thyroid testing during pregnancy may have variable and unreliable results.
Mild pathology may not be detected until after pregnancy.
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Guide to Herbal Medicines. Boston, Mass: Integrative Medicine
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
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.
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Treatment. Norwalk, Conn: Appleton & Lange;
Copyright © 2000 Integrative Medicine
CommunicationsThis 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
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