Management

Management

DOI: 10.4018/978-1-5225-9655-4.ch014

Abstract

Treatment of Hashimoto thyroiditis (HT) is mainly medical supplementing L-thyroxine (L-T4) for hypothyroidism. L-thyroxine has proved to reduce the volume of the thyroid gland in both hypothyroidism and euthyroid state. The dose of L-T4 is tailored according to the patient's needs; the standard dosage is 1.6-1.8 µ/kg/day. The level of TSH is frequently monitored for dose adjustment till euthyroid state is attained thereafter every 6-12 months. Thyroidectomy is considered in patients with cosmetic problem; with compressive symptoms (such as dysphagia, dyspnea, change of voice), suspicion of malignancy as papillary thyroid carcinoma is commonly associated. Surgery has a beneficial effect in cases of painful thyroiditis. Radioactive iodine treatment can be considered as a last option in elderly patients with large goiter who refuse surgery and their thyroiditis is not responding to L-T4 treatment. This chapter explores the management of Hashimoto's disease.
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Introduction

Hypothyroidism caused by Hashimoto's thyroiditis is treated with thyroid hormone replacement agents such as levothyroxine (L-T4), tri-iodothyronine or desiccated thyroid extract. A tablet taken once a day, generally keeps the thyroid hormone levels normal. In most cases, the treatment needs to be taken for the rest of the person's life. In the event that hypothyroidism is caused by Hashimoto's thyroiditis, it is recommended that the TSH levels be kept below 3.0 mU/L.

No Treatment - Observation and Monitoring

Many patients with Hashimoto's disease require no treatment, for frequently the disease is asymptomatic and the goiter is small. This approach is justified by the old study of Vickery and Hamlin. (1961), who found, on both clinical and pathologic grounds, that the disease may remain static and the clinical condition unchanged over many years.

Medical Treatment

The treatment of choice for Hashimoto thyroiditis (or hypothyroidism from any cause) is thyroid hormone replacement. The drug of choice is orally administered levothyroxine (L-T4) sodium, usually for life.

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