Thyroiditis: Symptoms, Types, Causes and Treatment

Thyroiditis encompasses a group of disorders involving inflammation of the thyroid gland, a small but mighty organ in the neck that regulates the body’s metabolism and hormone balance. Understanding thyroiditis is key for early detection, effective management, and improved patient quality of life. In this article, we’ll explore its symptoms, various forms, underlying causes, and current treatment strategies, drawing on evidence from recent research.

Symptoms of Thyroiditis

Recognizing the symptoms of thyroiditis can be challenging, as they often mimic other disorders or shift over time. Still, being aware of what to look for empowers early detection and prompt care.

Symptom	Description	Common Types	Source(s)
Neck swelling	Enlarged, sometimes tender gland	Hashimoto, Subacute	1 3 8
Fatigue	Persistent tiredness	Hashimoto, Postpartum	2 3 8
Weight change	Gain or loss	Hashimoto, Subacute	2 5 8
Pain	Usually in front of neck	Subacute thyroiditis	1 8 12
Mood changes	Anxiety, depression	All types	2 5 8
Menstrual issues	Irregular cycles	Hashimoto, Postpartum	2 8
Hair/skin changes	Hair loss, dry skin	Hashimoto	2 8
Temperature intolerance	Sensitivity to cold/heat	Hashimoto, Subacute	2 5 8

Table 1: Key Symptoms of Thyroiditis

Common Symptom Patterns

Thyroiditis often presents in phases. Initially, inflammation can cause a surge of thyroid hormones (thyrotoxicosis), leading to symptoms such as:

• Anxiety, irritability
• Palpitations
• Heat intolerance
• Unexplained weight loss

As the gland becomes depleted, hypothyroidism can follow, with symptoms such as:

• Fatigue
• Weight gain
• Constipation
• Cold intolerance
• Dry skin and hair loss
• Depression or cognitive slowing 2 3 5 8

Goiter and Neck Pain

A visible or palpable enlargement of the thyroid gland (goiter) is common, especially in Hashimoto’s and subacute thyroiditis. Subacute thyroiditis often causes significant neck pain and tenderness, which distinguishes it from the typically painless goiter of Hashimoto’s 1 3 8 12.

Menstrual and Mood Changes

Women—particularly those with Hashimoto’s or postpartum thyroiditis—may experience irregular menstrual cycles. Mood disturbances, including irritability, anxiety, or depression, are frequent and sometimes overlooked symptoms 2 8.

Other Physical Signs

• Muscle cramps
• Slow heart rate (bradycardia) in hypothyroidism
• Rapid heart rate (tachycardia) in hyperthyroid phases
• Hoarseness (when the gland compresses nearby structures) 2 3 8

Types of Thyroiditis

Thyroiditis is not a single disease but rather a spectrum of disorders, each with unique features, triggers, and trajectories. Here’s a concise overview.

Type	Defining Feature	Typical Course	Source(s)
Hashimoto’s	Autoimmune, painless goiter	Chronic, often permanent	1 2 3 8 11
Subacute (de Quervain’s)	Painful, post-viral	Self-limiting, triphasic	1 5 8 12
Postpartum	After childbirth	Temporary, triphasic	1 5 8
Silent (painless)	No pain, often autoimmune	Temporary, triphasic	5 8
Drug-induced	Triggered by medications	Variable	8
Riedel’s	Fibrous, rare	Progressive, can compress	4

Table 2: Major Types of Thyroiditis

Hashimoto’s Thyroiditis

• Most common form of thyroiditis and autoimmune thyroid disease.
• Characterized by a painless, firm goiter and symptoms of hypothyroidism (sometimes preceded by a brief hyperthyroid phase, “Hashitoxicosis”).
• Pathology shows lymphocytic infiltration and destruction of thyroid tissue.
• Predominantly affects women and can have several variants (fibrous, IgG4-related, juvenile) 1 2 3 11.

Subacute (De Quervain's) Thyroiditis

• Often follows a viral upper respiratory infection.
• Presents with severe, painful swelling of the thyroid and systemic symptoms (fever, malaise).
• Typical course involves a “triphasic” pattern: hyperthyroid phase (1-3 months), hypothyroid phase (up to 6 months), then recovery 1 5 8 12.
• Usually self-limited, with most patients eventually regaining normal thyroid function.

Postpartum Thyroiditis

• Occurs within one year of delivery, miscarriage, or abortion.
• Follows a similar triphasic course as subacute thyroiditis, but is painless.
• Women may present with either hyperthyroidism, hypothyroidism, or both sequentially 1 5 8.

Silent (Painless) Thyroiditis

• Shares features with postpartum thyroiditis, but not related to pregnancy.
• Autoimmune in nature, often transient 5 8.

Drug-Induced Thyroiditis

• Certain medications can cause thyroid inflammation, including amiodarone, interferons, lithium, and some cancer therapies.
• Course and resolution depend on the drug and patient 8.

Riedel’s Thyroiditis

• A very rare, chronic form marked by fibrosis, sometimes extending into surrounding neck structures.
• Can cause compressive symptoms, such as difficulty swallowing or breathing 4.

Causes of Thyroiditis

Understanding why thyroiditis develops is essential for prevention and targeted therapy. Causes can be diverse—ranging from autoimmunity to infections and external factors.

Cause	Mechanism	Commonly Associated Types	Source(s)
Autoimmunity	Immune attack on thyroid tissue	Hashimoto’s, Silent, Postpartum	2 3 7 11
Infection	Viral or, less commonly, bacterial	Subacute, Rarely others	1 5 6 9
Medications	Drug-induced inflammation	Drug-induced	8
Radiation	Glandular damage post-exposure	Variable	9 10
Genetics	Inherited risk factors	Hashimoto’s, others	2 7 10 11
Environmental	Iodine intake, stress, possible toxins	Hashimoto’s, Others	2 7 10 11

Table 3: Causes of Thyroiditis

Autoimmune Mechanisms

The most common cause of thyroiditis is autoimmunity. In Hashimoto’s, the immune system targets thyroid proteins (notably thyroid peroxidase and thyroglobulin), leading to chronic inflammation and eventual glandular destruction. A genetic predisposition, female sex, and environmental triggers (such as stress or infection) play significant roles 2 3 7 11.

• Hashimoto’s Thyroiditis: Classic autoimmune, marked by high levels of anti-thyroid antibodies.
• Silent & Postpartum Thyroiditis: Also considered autoimmune, though triggers (like hormonal changes after childbirth) may set off the process 1 5 8.

Infections

Subacute thyroiditis most often follows a viral infection (such as mumps, coxsackievirus, echovirus, or more recently, SARS-CoV-2). The immune response to the virus inadvertently damages thyroid cells, causing pain and transient hormone imbalance 1 5 6 9.

Drug-Induced and Radiation

Certain medications (amiodarone, lithium, interferons, immune checkpoint inhibitors) and radiation treatments for cancer can injure thyroid cells, leading to inflammation 8 10.

Genetic and Environmental Factors

Family history increases risk, and environmental factors such as high iodine intake, stress, or exposure to certain chemicals may trigger autoimmune thyroiditis in genetically susceptible individuals 2 7 10 11.

• Parvovirus B19 has been implicated in some cases, particularly in patients with detectable anti-TPO antibodies 9.

Treatment of Thyroiditis

Effective management of thyroiditis depends on its type, severity, and phase. Treatment may be supportive, symptomatic, or targeted at underlying causes.

Treatment	Target Condition/Phase	Indication	Source(s)
Levothyroxine	Hypothyroidism (esp. Hashimoto)	Persistent or symptomatic hypothyroidism	1 2 3 8 11
Beta blockers	Hyperthyroid (thyrotoxic) phase	Symptom control (palpitations, tremor)	1 8 11
NSAIDs	Subacute thyroiditis, pain relief	Mild to moderate pain/inflammation	1 8 12
Corticosteroids	Severe subacute/painful thyroiditis	Severe inflammation, refractory cases	1 8 12
Selenium, Vitamin D	Hashimoto’s (adjunctive)	Possible benefit in select cases	2
Surgery	Large goiter, compression, malignancy concern	Rare, severe cases	3 8
Drug withdrawal	Drug-induced thyroiditis	When possible	8

Table 4: Main Treatments for Thyroiditis

Hormone Replacement Therapy

• Levothyroxine is the mainstay for treating hypothyroidism, especially in Hashimoto’s and in the hypothyroid phase of postpartum or subacute thyroiditis. Dosing is individualized based on body weight and residual thyroid function 1 2 3 8 11.
• Lifelong therapy is often necessary for Hashimoto’s, while in others, temporary use may suffice.

Symptom Management in Hyperthyroid Phase

• Beta blockers alleviate symptoms like palpitations, tremors, and anxiety during the thyrotoxic phase.
• Antithyroid drugs are typically not effective because the hyperthyroidism is due to hormone leakage, not overproduction 1 8 11.

Pain and Inflammation Relief

• NSAIDs are first-line for pain in subacute thyroiditis.
• Corticosteroids (e.g., prednisone) are reserved for severe pain or cases unresponsive to NSAIDs. Recent evidence suggests that a low initial steroid dose with gradual tapering helps minimize recurrence 12.

Supportive and Adjunct Therapies

• Selenium and Vitamin D supplementation have been explored in Hashimoto’s, though evidence for routine use is limited and should be individualized 2.
• Diet and lifestyle modifications (e.g., stress reduction, balanced diet) may provide additional support but are not substitutes for medical therapy 2 10.

Surgical Intervention

• Rarely indicated, surgery may be necessary for massive goiters causing compression or if there is suspicion of cancer 3 8.

Monitoring and Follow-Up

• Regular monitoring of thyroid function tests (TSH, free T4, T3) is crucial for adjusting therapy and detecting progression or resolution 1 8 11.
• Postpartum and silent thyroiditis often require only observation unless symptoms are pronounced or persistent.

Conclusion

Thyroiditis is a multifaceted group of disorders that requires attentive diagnosis and individualized care. Here’s what you need to remember:

• Symptoms vary widely, commonly including neck swelling, fatigue, pain, and changes in weight, mood, or menstruation.
• Types of thyroiditis range from chronic autoimmune (Hashimoto’s) to temporary inflammatory forms (subacute, postpartum, silent), each with unique features and prognosis.
• Causes encompass autoimmune processes, infections, medications, genetic predisposition, and environmental factors.
• Treatment is tailored to the type and phase of thyroiditis, focusing on hormone replacement, symptom relief, and, when necessary, anti-inflammatory or surgical interventions.
• Regular monitoring is key to effective management and prevention of complications.

Key Takeaways:

• Thyroiditis is not a single disease but a spectrum, with different causes and clinical courses.
• Early recognition and appropriate therapy can significantly improve outcomes.
• Many forms are manageable and even self-limited, but chronic types (like Hashimoto’s) often require lifelong attention.
• Multidisciplinary care—endocrinologists, primary care, and sometimes surgeons—offers the best chance for optimal patient outcomes.