Introduction:

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 and drug induced thyroiditis. Most forms of thyroiditis result in three phases: overactive thyroid (hyperthyroidism), underactive thyroid (hypothyroidism), and return to normal. When the thyroid is inflamed, it often releases an excess of thyroid hormone, resulting in hyperthyroidism. Alternatively, when the supply of thyroid hormone is depleted, the body has too little, and hypothyroidism results. Young to middle aged women are at greatest risk, however, some forms of thyroiditis occur in both men and women of all ages. With some forms, hypothyroidism may develop years later, even if the thyroiditis has resolved.

Signs and Symptoms:

Depending on the type of thyroiditis, the thyroid gland can have one of the following characteristics:

• 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, or slow reflexes
• No desire to eat, feeling tired and unenergetic, and a slight fever
• Constipation
• A rapid heartbeat, slight nervousness, anxiety, weight loss of 5 - 10 pounds, and increased sweating

What Causes It?:

Immune disorders, viruses, and fever disorders can cause thyroiditis. Sometimes thyroiditis develops if you have Graves' disease (an autoimmune disorder that causes hyperthyroidism). Certain drugs, such as amiodarone, interferon-alpha, inter leukin-2, or lithium can also cause thyroiditis. Pregnant women who test positive for the thyroid antibody during their first trimester have a 30 - 50% chance of developing thyroiditis during the postpartum period. Excessive iodine intake may also contribute to thyroid disorders. In some cases or thyroiditis, there is no identifiable cause.

What to Expect at Your Provider's Office:

Your health care provider will feel your neck to see if the thyroid gland is enlarged or inflamed and may request an ultrasound of your thyroid gland. Your provider may also order blood tests to check the levels of thyroid hormones and antibodies. You may receive medication to help alleviate your symptoms.

Natural medicine practitioners often take a different view of laboratory analysis of thyroid function. Many naturally oriented doctors pay particular attention to levels of T3 hormone, the active form of thyroid hormone that is converted in the body from T4, an inactive thyroid hormone. Conventional lab tests usually monitor T4 and thyroid stimulating hormone (TSH) without examining levels of T3. People with hypothyroidism may be treated with T4 to bring their levels of T4 to normal limits. Meanwhile, if you are unable to convert T4 to T3, your tests may be normal but you may still experience the symptoms of hypothyroidism. Talk to your doctor about including T3 lab tests in the treatment of hypothyroidism.

Treatment Options:

Thyroiditis generally involves three phases: overactive phase, underactive phase, and return to normal. Treatment is individualized to type and phase.

Drug Therapies

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

• Levothyroxine, if hypothyroidism or large goiter present
• Aspirin, to relieve pain and inflammation
• Corticosteroid medications (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 thyroid removal may relieve pressure.

Complementary and Alternative Therapies

Alternative therapies can help when used along with the medications your health care provider prescribes, but do not replace conventional medications. 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 depress thyroid activity are broccoli, cabbage, Brussels sprouts, cauliflower, kale, spinach, turnips, soy, beans, and mustard greens. You should include these foods in a diet for hyperthyroid conditions -- and avoid them if you have a hypothyroid condition. 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 (1,000 - 1,500 mg three times per day), found in flaxseed oil, fish oil, and borage oil, are anti-inflammatory and necessary for hormone production. Essential fatty acids can increase the blood thinning effects of certain medications, including Coumadin, Plavix, or aspirin. Check with your health care provider.
• Bromelain (250 - 500 mg 3 times per day between meals), an enzyme from the pineapple plant, may reduce inflammation. Bromelain can increase blood thinning effects of certain medications. Check with your physician.
• Vitamin C (1,000 mg per day), vitamin A (10,000 - 25,000 IU per day), B complex [(50 -100 mg per day), augmented with vitamins B2 (riboflavin, 10 mg), B3 (niacin, 10 - 25 mg), and B6 (pyridoxine, 5 - 15 mg)], selenium (200 mcg per day), vitamin E (400 IU per day), and zinc (30 mg per day) are necessary for normal thyroid hormone production.
• Calcium (1,000 mg per day) and magnesium (200 - 600 mg per day) may help metabolic processes function correctly.
• If you take thyroid hormone medication, talk to your doctor before consuming soy products. Some evidence suggests that soy may interfere with absorption of thyroid hormone.
• Iron may also interfere with the absorption of thyroid hormone medication.

Your health care provider may also recommend specific nutritional supplements for a hyperthyroid or hypothyroid condition.

Herbs

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

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

For hyperthyroid conditions:

• Bugleweed (Lycopus virginica) and lemon balm (Melissa officinalis) help normalize the overactive thyroid. Steep the following amount in one cup of boiling water. Strain and cool. For bugleweed, 1 - 2 g; for lemon balm, 2 tablespoons. These herbs may be combined. Bugleweed may interact with some diabetes medications.
• Motherwort (Leonurus cardiaca) can help regulate rapid heartbeat. Steep 2 g in one cup of boiling water. Strain and cool. Drink 3 times per day. Do not take motherwort along with sedating medications.
• Turmeric (Curcuma longa) makes the effect of bromelain stronger and should be taken between meals, 500 mg 3 times per day. Turmeric can increase the blood thinning effects of certain medications, such as Coumadin. Speak with your physician.
• Avoid ashwagandha (Withania somnifera) and bladderwrack (Fucus vesiculosus), as they can stimulate hyperthyroidism.

For hypothyroid conditions:

• Coleus forskohlii (50 - 100 mg 2 - 3 times per day) may stimulate thyroid function to increase thyroid hormone. Do not take coleus if you are taking blood thinning medications or Nitrates. Coleus may increase the blood thinning effects of cetain medications, such as Coumadin.
• Herbs such as guggul (Commiphora mikul) (25 mg of guggulsterones 3 times per day) and hawthorne (Crataegus monogyna) (500 mg twice a day) are taken to counteract high cholesterol, which often accompanies hypothyroidism. Guggul can interact with many medications, particularly hormone medications, such as oral contraceptives, and other medications, such as Diltiazem (Cardizem, Dilacor, Tiazac). Guggul may also increase bleeding. Speak with your physician. Hawthorne can interact with various blood pressure medications and can increase the blood pressure lowering effects of drugs used to treat male sexual dysfunction, such as Viagra. Hawthorne may also interfere with Nitrate medications.

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 perform 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 maternal thyroid hormone deficiency can lead to neurodevelopment complications in the fetus. Careful monitoring is necessary.

Alternative Names:

Thyroid inflammation