Treatment of immune thyroiditis

The treatment of immune thyroiditis should be carried out symptomatically. Patients with dormant lymphocytic thyroiditis can be treated conservatively in the early stages and some anti-thyroid drugs can be used, because surgery and radiotherapy are not suitable at this time.

1. Silent lymphocytic thyroiditis

The disease is transient, lasting only a few months; the hyperthyroid phase should be treated conservatively, usually with only beta-blockers. Antithyroid drugs, surgery, and radiation therapy are contraindicated. Transient hypothyroidism may require thyroid hormone replacement therapy. Although hypothyroidism may be permanent in some cases, most people return to normal thyroid function, so thyroid function should be reassessed after 6 to 12 months.

2. Subacute thyroiditis

For more severe and prolonged cases, corticosteroids are recommended, and all symptoms will disappear within 24 to 48 hours. When thyroid radioiodine uptake returns to normal, treatment is terminated.

3. Acute thyroiditis

Cold compress is suitable for local use in the early stage, hot compress is suitable for use in the late stage, and antibiotics are given systemically. When there is an abscess, incision and drainage should be performed early to prevent the abscess from rupturing into the trachea, esophagus, or mediastinum. Treatment includes antibiotics and local incision and drainage. It is best to do puncture fluid and blood culture, and perform drug sensitivity tests, and then choose sensitive antibiotics, which will be more effective in eliminating bacteria. After a few days of thyroid inflammation, an abscess will form. Therefore, the thyroid abscess must be incised and drained to effectively remove the pus and control the local inflammation as soon as possible. Because the neck pain is obvious, some pain-relieving drugs can be used.

4. Hashimoto’s thyroiditis

Patients with mild thyroid enlargement and no symptoms may not need treatment but should be followed up and observed. When the thyroid gland is significantly enlarged or there is hypothyroidism, thyroid preparations should be given for treatment even if only serum TSH is elevated. If the thyroid gland enlarges rapidly or is accompanied by pain or compression symptoms, short-term glucocorticoid treatment can be used. Hashimoto's hyperthyroidism should be treated with low-dose antithyroid drugs, and 131 iodine and surgery are generally not used to avoid severe hypothyroidism.