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Treatment of autoimmune chronic thyroiditis
Last reviewed: 06.07.2025
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Treatment of autoimmune thyroiditis should begin with the administration of thyroid hormones. Increasing the concentration of thyroxine and triiodothyronine in the blood inhibits the synthesis and release of thyroid-stimulating hormone, thereby stopping further growth of the goiter. Since iodine can play a provoking role in the pathogenesis of autoimmune thyroiditis, dosage forms with a minimum iodine content should be preferred. These include thyroxine, triiodothyronine, combinations of these two drugs - thyrotom and thyrotom forte, Novotirol. Thyreokomb, containing 150 mcg of iodine per tablet, is preferable for the treatment of hypothyroidism in endemic goiter, as it replenishes the lack of iodine and stimulates the work of the gland itself. Despite the fact that sensitivity to thyroid hormones is strictly individual, people over 60 years of age should not be prescribed a dose of thyroxine greater than 50 mcg, and triiodothyronine intake should begin with 1-2 mcg, increasing the dose under ECG control.
The use of glucocorticoids in autoimmune thyroiditis is problematic, unlike thyroid hormone therapy, since their immunosuppressive effect is manifested only at relatively high doses and long-term use. In this case, side effects are possible (osteoporosis, hyperglycemia, arterial hypertension, formation of steroid ulcers on the gastric mucosa). After discontinuation of the drug, the immunosuppressive effect ceases. Therefore, the use of glucocorticoids in chronic thyroiditis should be strictly determined by necessity: firstly, if adequate replacement therapy does not lead to a decrease in the size of the goiter within 3-4 months of treatment; secondly, when a rare form of chronic thyroiditis with pain syndrome is observed. The drug is prescribed in such a situation for anti-inflammatory purposes against the background of taking thyroid hormones. The initial dose of prednisolone is 40-30 mg / day and is reduced by 5 mg every 10-12 days.
The total duration of treatment is 2.5-3 months. Reduction of the gland size and pain relief are achieved where inflammatory changes prevail. If fibrosis has developed, no effect is observed. If the goiter continues to grow, an urgent puncture biopsy followed by surgery is required. Surgical treatment for chronic thyroiditis is performed according to absolute indications, which include, firstly, rapidly growing goiters (risk of malignancy); secondly, large goiters compressing the trachea and main vessels; thirdly, rare painful forms of goiter that do not respond to conservative therapy. Total goiterectomy is performed.