Thyroiditis

Thyroiditis is an inflammation of the thyroid gland. It may be painful and tender when caused by an infection or trauma, or painless when caused by an autoimmune condition or medications.

There are several types of thyroiditis. The most common forms are:

• Hashimoto's disease
• Subacute granulomatous thyroiditis
• Postpartum thyroiditis
• Subacute lymphocytic thyroiditis
• Drug-induced thyroiditis

Most forms of thyroiditis result in 3 phases:

• Overactive thyroid (hyperthyroidism)
• Underactive thyroid (hypothyroidism)
• A return to normal

When the thyroid is inflamed, it often releases too much thyroid hormone, causing hyperthyroidism. Then, when there is no more thyroid hormone to release, the body does not have enough, causing hypothyroidism.

Young to middle aged women are at the greatest risk. However, some forms of thyroiditis happen in both men and women of all ages. Sometimes, you may develop hypothyroidism years later, even if the thyroiditis was treated.

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Signs and Symptoms

Depending on the type of thyroiditis, the thyroid gland can be:

• Firm and enlarged, but not tender
• Enlarged and painful, with pain extending to the jaw or ears
• Enlarged, but not painful
• Enlarged on only one side, hard like a stone, and sticking to other neck structures

You may also have one or more of the following symptoms:

• Cool, dry skin
• Slow pulse rate (fewer than 60 beats per minute)
• Swelling around the eyes
• Hoarseness
• Slow reflexes
• No desire to eat
• Feeling tired and unenergetic
• A slight fever
• Constipation
• Heat intolerance
• A rapid heartbeat, slight nervousness, anxiety, and increased sweating
• Weight loss of 5 to 10 pounds

In some cases, especially postpartum thyroiditis, there may be no symptoms.

What Causes It?

Possible causes of thyroiditis include:

• Problems with the immune system
• Viruses
• Fever disorders
• Certain drugs, such as amiodarone, interferon-alpha, inter leukin-2, or lithium

Sometimes thyroiditis develops if you have Graves' disease, an autoimmune disorder that causes hyperthyroidism.

Pregnant women who test positive for the thyroid antibody during their first trimester have a 30% to 50% chance of developing thyroiditis after delivery. Too much iodine may also contribute to thyroid disorders.

In some cases of thyroiditis, no cause can be found.

What to Expect at Your Doctor's Office

Your doctor will feel your neck to see if the thyroid gland is enlarged or inflamed, and may order an ultrasound of your thyroid gland. Your doctor may also order blood tests to check the levels of thyroid hormones and antibodies in your system. You may get medication to help relieve your symptoms.

Natural medicine practitioners often take a different view of laboratory results of thyroid function. Many naturally-oriented doctors pay particular attention to levels of T3 hormone. That is the active form of thyroid hormone that your body makes from T4, an inactive thyroid hormone. Conventional lab tests usually measure T4 and thyroid stimulating hormone (TSH) without examining levels of T3. If you have hypothyroidism, your doctor may treat it with T4 to bring your levels of T4 to normal limits. If your body cannot convert T4 to T3, your tests may be normal, but you may still have symptoms of hypothyroidism. Talk to your doctor about including T3 lab tests in the treatment of hypothyroidism.

Treatment Options

Thyroiditis generally involves 3 phases:

• Overactive phase
• Underactive phase
• Return to normal

Treatment depends on the type of thyroiditis and the phase.

Drug Therapies

Depending on the particular type of thyroiditis, a doctor may prescribe one or more of the following treatments:

• Levothyroxine, for hypothyroidism or large goiter
• Pain and inflammation relievers
• Corticosteroids, such as prednisone or dexamethasone, to reduce inflammation in severe cases
• Propanolol, for hyperthyroidism
• Thyroxine, to replace thyroid hormone (in cases of hypothyroidism)
• Short-term beta blockers, for hyperthyroid symptoms
• Antibiotics

Surgical and Other Procedures

In rare cases, partial removal of the thyroid may relieve pressure.

Complementary and Alternative Therapies

Alternative therapies can help when used along with the medications your doctor prescribes. DO NOT use alternative therapies by themselves to treat thyroiditis. Make sure your doctor knows about any alternative therapies you are using or considering using. Some supplements can interfere with conventional medications.

Nutrition and Supplements

• Foods that can potentially lower thyroid activity are broccoli, cabbage, Brussels sprouts, cauliflower, kale, spinach, turnips, soy, beans, and mustard greens. These foods may help if your thyroid gland is overactive (hyperthyroidism). If it is underactive, ask your doctor if you should avoid these foods. Cooking deactivates some of the thyroid-lowering effects. Use caution because people with thyroiditis can switch from hyperthyroidism to hypothyroidism very quickly.
• Avoid refined foods, sugar, dairy products, wheat, caffeine, alcohol.
• Essential fatty acids, found in flaxseed oil, fish oil, and borage oil, are anti-inflammatory. They can increase the risk of bleeding, especially if you also take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin.
• Bromelain, an enzyme from the pineapple plant, may reduce inflammation. It is often combined with turmeric, because turmeric makes the effects of bromelain stronger. Both bromelain and turmeric can increase the risk of bleeding, especially if you also take blood thinners.
• Vitamin C; vitamin A; B complex, with vitamins B2 (riboflavin), B3 (niacin), and B6 (pyridoxine); selenium, vitamin E, and zinc are needed for normal thyroid hormone production.
• Vitamin D is important to protect against thyroiditis. Some studies suggest that a vitamin D deficiency increases the risk of developing thyroiditis. Talk to your doctor.
• L-carnitine may help treat hyperthyroidism that is caused by taking thyroid hormone for benign goiter. Taking thyroid hormone for goiter sometimes results in getting a little too much and having mild hyperthyroidism. One study found that among women taking thyroid hormone for benign goiter, taking l-carnitine reduced symptoms, such as heart palpitations and nervousness. Researchers think l-carnitine may stop thyroid hormone from getting into the body's cells. L-carnitine may increase the risk of bleeding, especially if you also take blood thinners.
• If you take thyroid hormone medication, talk to your doctor before eating soy. Some evidence suggests that soy may make it harder to absorb thyroid hormone.
• Iron may also interfere with the absorption of thyroid hormone medication.
• Selenium may help prevent against thyroiditis. Speak to your doctor.

Your doctor may also recommend specific nutritional supplements for a hyperthyroid or hypothyroid condition.

Herbs

Herbs are a way to strengthen and tone the body's systems. As with any therapy, you should work with your doctor before starting treatment. You may use herbs as dried extracts (capsules, powders, or teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. (5 g) herb per cup of hot water. Steep covered 5 to 10 minutes for leaves or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

Talk to your doctor before taking herbs for thyroiditis, particularly if you are also taking prescription medication.

For hyperthyroid conditions:

• Bugleweed (Lycopus virginica) and lemon balm (Melissa officinalis). May help normalize the overactive thyroid. Some animal and test tube studies suggest bugleweed may help, but human studies are needed. Bugleweed may interact with some diabetes medications.
• Motherwort (Leonurus cardiaca). May help regulate rapid heartbeat, a common symptom of hyperthyroidism. DO NOT take motherwort along with sedating medications, including some antihistamines. Motherwort can potentially cause miscarriage and increase uterine bleeding. Motherwort can also potentially interfere with many cardiac medications. Speak with your physician.
• Turmeric (Curcuma longa). Makes the effect of bromelain stronger. Both turmeric and bromelain can increase the risk of bleeding, especially if you also take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin. DO NOT take turmeric if you have gall bladder issues.
• Avoid ashwagandha (Withania somnifera) and bladderwrack (Fucus vesiculosus). They can make hyperthyroidism worse.

For hypothyroid conditions:

• Coleus forskohlii. Has been used in Ayurvedic medicine to stimulate thyroid function, although there aren't any scientific studies using it to treat hypothyroidism. DO NOT take coleus if you are taking blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, or nitrates, such as nitroglycerine. Coleus may lower blood pressure, so if you take medications for high blood pressure you run the risk of your blood pressure dropping too low. Coleus can interfere with a number of medications, particularly medications used to treat cardiovascular disease.

You should carefully monitor any treatment for lowering or raising thyroid function because thyroiditis may switch from hyperthyroidism to hypothyroidism very quickly.

Homeopathy

Homeopathy may be useful as a supportive therapy for both hypothyroidism and hyperthyroidism.

Physical Medicine

Exercise helps improve thyroid function for both hypothyroidism and hyperthyroidism.

Acupuncture

Acupuncture may help correct hormonal imbalances and address underlying deficiencies and excesses involved in thyroiditis.

Massage

Therapeutic massage may relieve stress and increase the sense of well being.

Following Up

Your health care provider may order frequent blood tests to make sure your thyroid hormone levels fall within the normal range.

Special Considerations

Thyroid disorders are one of the most common endocrine disorders in pregnant women. Even mild thyroid hormone deficiency can cause problems with the fetus, so your doctor will watch your thryoid levels closely.

Supporting Research

Benvenga S, Lakshmanan M, Trimarchi F. Carnitine is a naturally occurring inhibitor of thyroid hormone nuclear uptake. Thyroid. 2000;10:1043-1050.

Benvenga S, Ruggeri RM, Russo A, et al. Usefulness of L-carnitine, a naturally occurring peripheral antagonist of thyroid hormone action, in iatrogenic hyperthyroidism: a randomized, double-blind, placebo-controlled clinical trial. J Clin Endocrinol Metab. 2001;86:3579-3594.

Bindra A, Braunstein GD. Thyroiditis. Am Fam Physician. 2006;73(10):1769-1776.

Buffet C, Groussin L. Thyroiditis. Rev Prat. 2013;63(2):171-177.

Camargo RY, Tomimori EK, Neves SC, et al. Thyroid and the environment: exposure to excessive nutritional iodine increases the prevalence of thyroid disorders in Sao Paulo, Brazil. Eur J Endocrinol. 2008;159(3):293-299.

Duntas LH. Environmental factors and autoimmune thyroiditis. Nat Clin Pract Endocrinol Metab. 2008;4(8)454-460.

Ferri FF, ed. Ferri's Clinical Advisor 2014. 1st ed. St. Louis, MO: Elsevier Mosby; 2013.

Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier Saunders; 2016.

Krysiak R, Kowalska B, Okopien B. Serum 25-Hydroxyvitamin D and parathyroid hormone levels in non-lactating women with post-partum thyroiditis: the effect of L-thyroxine treatment. Basic Clin pharmacol Toxicol. 2015;116(6):503-507.

Krysiak R, Okopie B, Herman ZS. Postpartum thyroiditis. Pol Merkur Lekarski. 2006;20(120):721-726.

Lacka K, Maciejewski A. Vitamin D in th etiopathogenesis of autoimmune thyroiditis. Pol Merkur Lekarski. 2013;34(203):281-285.

Mazokopakis EE, Chatzipavlidou V. Hashimoto's thyroiditis and the role of selenium. Current concepts. Hell J Nucl Med. 2007;10(1):6-8.

Maleki N, Tavosi Z. Evaluation of thyroid dysfunction and autoimmunity in gestational diabetes mellitus and its relationship with postpartum thyroiditis. Diabet Med. 2015;32(2):206-212.

Messina M, Redmond G. Effects of soy protein and soybean isoflavones on thyroid function in healthy adults and hypothyroid patients: a review of the relevant literature. Thyroid. 2006 Mar;16(3):249-258.

Noureldine SI, Tufano RP. Association of Hashimoto's thyroiditis and thyroid cancer. Curr Opin Oncol. 2015;27(1):21-25.

Paknys G, Kondrotas AJ, Kevelaitis E. Hashimoto's thyroiditis. Medicina. 2009;45(7):574-583.

Petricca D, Nacamulli D, Mian C, et al. Effects of selenium on the natural course of autoimmune thyroiditis: a short review. J Endocrinol Invest. 2012;35(4):419-424.

Rashid M, Rashid MH. Obstetric management of thyroid disease. Obstet Gynecol Surv. 2007;62(10):680-688.

Sweeney LB, Stewart C, Gaitonde DY. Thyroiditis: an integrated approach. Am Fam Physician. 2014;90(6):389-396.

Svensson J, Ericsson UB, Nilsson P, et al. Levothyroxine treatment reduces thyroid size in children and adolescents with chronic autoimmune thyroiditis. J Clin Endocrinol Metab. 2006;91(5):1729-1734.

Ventura A, Ronsoni MF, Shiozawa MB, et al. Prevalence and clinical features of celiac disease in patients with autoimmune thyroiditis: cross-sectional study. Sao Paulo Med J. 2014;132(6):364-371.

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Herbs

Ginkgo biloba Horsetail Lemon balm Passionflower

Supplements

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

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Review Date: 6/2/2016  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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