Thyroiditis

The main forms

• Hashimoto’s thyroiditis: an autoimmune condition that can lead to hypothyroidism.
• Subacute thyroiditis: often painful, after a viral infection, with temporary hormonal changes.
• Painless and postpartum thyroiditis: may pass from excess hormone to deficiency.
• Forms linked to drugs (amiodarone, interferon, immunotherapy) and, more rarely, infections.

The course varies with the cause. Some forms recover; others, such as Hashimoto’s, need long-term follow-up and usually lead to permanent hypothyroidism.

What the symptoms are

In the phase of hormone excess there may be palpitations, tremor and sweating (see hyperthyroidism). In the hypothyroid phase, fatigue, cold intolerance, constipation and weight gain may appear. Subacute thyroiditis can cause pain at the front of the neck, spreading toward the jaw and ear, with mild fever. Hashimoto’s may be discovered without symptoms, or with a painless enlargement of the gland (goiter).

How it is diagnosed

The doctor assesses symptoms, recent childbirth, infections and medicines. TSH and FT4 are used; antibodies (anti-TPO, anti-thyroglobulin) and markers of inflammation (ESR, CRP) are added as appropriate. Ultrasound can help assess structure (a heterogeneous appearance in Hashimoto’s, hypoechoic areas in subacute thyroiditis), but is not automatically needed in every case. Positive antibodies with normal hormones do not necessarily mean treatment should start.

Why treatment differs from hyperthyroidism

In some thyroiditis, stored hormone is released from damaged cells. The thyroid is not necessarily producing more hormone, so drugs that block its production usually do not help in this phase. Treatment may target pain (anti-inflammatory drugs, corticosteroids in selected cases), temporary symptoms (beta-blockers) or replacement of hormone with levothyroxine when there is hypothyroidism. The decision is made according to the form and the tests.

What follow-up is needed

Function can change over time, so the doctor sets the checks; in Hashimoto’s, monitoring TSH every 6 months to a year, or sooner when the doctor considers it reasonable, is more useful than routinely repeating antibody levels. Tell your doctor of a planned or confirmed pregnancy, because levothyroxine needs increase. Do not change medicines and do not take iodine or thyroid supplements without advice.

Care at Tirana Polyclinic: we offer endocrinology consultation, thyroid ultrasound when needed and interpretation of tests to follow thyroid function.