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Endocrinology82 papers

Thyroiditis

Last edited: 4/14/2026

Overview

Hashimoto's thyroiditis (HT) is an autoimmune disorder characterized by chronic inflammation of the thyroid gland, leading to hypothyroidism and elevated thyroid autoantibodies. It is the most common cause of hypothyroidism worldwide 112.

Diagnosis

  • Elevated serum levels of thyroid peroxidase (TPO) antibodies and thyroglobulin antibodies 113.
  • Low or low-normal serum thyroxine (T4) and elevated thyroid-stimulating hormone (TSH) levels 15.
  • Thyroid ultrasound showing hypoechogenicity and increased vascularity 19.
  • Fine-needle aspiration biopsy may reveal lymphocytic infiltration 19.

    • Management

  • First-line treatment: Levothyroxine replacement therapy to normalize TSH levels 112.
  • Adjunctive treatments:
    • - Vitamin D supplementation to potentially improve thyroid function and reduce autoantibodies 67 (Evidence: Moderate). - Consideration of dietary supplements and herbal medicines, though evidence varies; specific efficacy is not conclusively established 23.

    Special Populations

  • Pregnancy: Close monitoring of thyroid function is essential; levothyroxine dose adjustments may be necessary 4.
  • Pediatrics: Management practices may differ, with pediatric endocrinologists potentially adopting more conservative approaches compared to adult specialists 1.
  • Elderly: Increased vigilance for metabolic disorders and nutritional deficiencies, such as vitamin D deficiency, is recommended 5.

    • Key Recommendations

  • Initiate levothyroxine therapy to maintain euthyroid status as evidenced by normal TSH levels (Evidence: Strong 112).
  • Evaluate and address vitamin D deficiency in HT patients, considering supplementation to potentially improve thyroid autoimmunity (Evidence: Moderate 67).
  • Regular monitoring of thyroid function and autoantibody levels is crucial for all HT patients to guide treatment adjustments (Evidence: Expert opinion 15).

    • References

    1 Yeşiltepe Mutlu G, Özcabı B, Sağsak E, Dağdeviren Çakır A, Özer Y, Kara C. Current Practices in Hashimoto’s Thyroiditis: Differences in Attitudes Between Pediatric and Adult Endocrinologists in Türkiye: A National Survey. Journal of clinical research in pediatric endocrinology 2025. link 2 Peng B, Wang W, Gu Q, Wang P, Teng W, Shan Z. Effects of different supplements on Hashimoto's thyroiditis: a systematic review and network meta-analysis. Frontiers in endocrinology 2024. link 3 Luo J, Zhou L, Sun A, Yang H, Zhang P, Liu K et al.. Herbal medicine for Hashimoto's thyroiditis: A systematic review and network meta-analysis. Journal of ethnopharmacology 2024. link 4 Gokkaya N. Subacute thyroiditis: a rare presentation in pregnancy. Endokrynologia Polska 2024. link 5 Mikulska-Sauermann AA, Resztak M, Karaźniewicz-Łada M, Filipowicz D, Ruchała M, Główka FK. Assessment of Vitamin Concentrations in Patients with Hashimoto's Thyroiditis and Their Relationships with Thyroid Function, Biochemical Status, and Anthropometric Parameters-A Preliminary Study. Nutrients 2024. link 6 Tang J, Shan S, Li F, Yun P. Effects of vitamin D supplementation on autoantibodies and thyroid function in patients with Hashimoto's thyroiditis: A systematic review and meta-analysis. Medicine 2023. link 7 Lebiedziński F, Lisowska KA. Impact of Vitamin D on Immunopathology of Hashimoto's Thyroiditis: From Theory to Practice. Nutrients 2023. link 8 Hu X, Wang X, Liang Y, Chen X, Zhou S, Fei W et al.. Cancer Risk in Hashimoto's Thyroiditis: a Systematic Review and Meta-Analysis. Frontiers in endocrinology 2022. link 9 Yuan J, Qi S, Zhang X, Lai H, Li X, Xiaoheng C et al.. Local symptoms of Hashimoto's thyroiditis: A systematic review. Frontiers in endocrinology 2022. link 10 Mikulska AA, Karaźniewicz-Łada M, Filipowicz D, Ruchała M, Główka FK. Metabolic Characteristics of Hashimoto's Thyroiditis Patients and the Role of Microelements and Diet in the Disease Management-An Overview. International journal of molecular sciences 2022. link 11 Góralska M, Podlewska M, Żach M. Riedel's thyroiditis - difficulties in differentiating from thyroid cancer. Endokrynologia Polska 2021. link 12 Weetman AP. An update on the pathogenesis of Hashimoto's thyroiditis. Journal of endocrinological investigation 2021. link 13 Hanna HWZ, Rizzo C, Abdel Halim RM, El Haddad HE, Salam R, El-Sayed Abou-Youssef H. Vitamin D status in Hashimoto's thyroiditis and its association with vitamin D receptor genetic variants. The Journal of steroid biochemistry and molecular biology 2021. link 14 Wang XL, Wang YX, Liu M, Cheng Y, He XJ, Zhang YL. Twin sisters with Hashimoto's thyroiditis and Henoch-Schönlein purpura. Endokrynologia Polska 2020. link 15 Dai L, Lin S, Liu D, Wang Q. Acute suppurative thyroiditis with thyroid metastasis from oesophageal cancer. Endokrynologia Polska 2020. link 16 Valderrama-Hinds LM, García-Carrión E, Hernández E, Agostini MI, Reyes-Morales OR, Fung L et al.. Prevalence of undifferentiated inflammatory arthropathy in patients with Hashimoto's thyroiditis in an endocrinology clinic. International journal of rheumatic diseases 2019. link 17 Millington K, Charrow A, Smith J. Case Series: Minocycline-Associated Thyroiditis. Hormone research in paediatrics 2019. link 18 Krysiak R, Kowalcze K, Okopień B. The effect of vitamin D on thyroid autoimmunity in euthyroid men with autoimmune thyroiditis and testosterone deficiency. Pharmacological reports : PR 2019. link 19 Garon-Czmil J, Petitpain N, Rouby F, Sassier M, Babai S, Yelehe-Okouma M et al.. Thyroiditis and immune check point inhibitors: the post-marketing experience using the French National Pharmacovigilance database. Fundamental & clinical pharmacology 2019. link 20 Stuart A. The changing scene in Hashimoto's disease: a review. Medical hypotheses 2011. link 21 Tacon L, Tan CT, Alvarado R, Gill AJ, Sywak M, Fulcher G. Drug-induced thyroiditis and papillary carcinoma in a minocycline-pigmented black thyroid gland. Thyroid : official journal of the American Thyroid Association 2008. link 22 Kon YC, DeGroot LJ. Painful Hashimoto's thyroiditis as an indication for thyroidectomy: clinical characteristics and outcome in seven patients. The Journal of clinical endocrinology and metabolism 2003. link 23 Jasmi AY, Rohaizak, Meah FA, Sulaiman BT. Typhoid thyroiditis. The Medical journal of Malaysia 1998. link 24 Sulimani RA. Lymphocytic thyroiditis presenting as a unilateral painful goitre. East African medical journal 1997. link 25 McRorie ER, Chalmers J, Campbell IW. Riedel's thyroiditis complicated by hypoparathyroidism and hypothyroidism. Scottish medical journal 1993. link 26 von Graevenitz A, Colla F. Thyroiditis due to Brucella melitensis--report of two cases. Infection 1990. link 27 Evengård B, Julander I. Suppurative Staphylococcus aureus thyroiditis. Scandinavian journal of infectious diseases 1986. link 28 Field LM. Management of a case of chronic radiodermatitis on the forehead. The Journal of dermatologic surgery and oncology 1981. link 29 Millar AJ. Acute suppurative thyroiditis. A case report. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1980. link 30 Gordon M. "Silent" thyroiditis with symptomatic hyperthyroidism in an elderly patient. Journal of the American Geriatrics Society 1978. link 31 Schneider RJ. Orbital involvement in Riedel's struma. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 1976. link 32 Roitt IM, Torrigiani G, Doniach D. Immunochemical studies on the thyroglobulin autoantibody system in human thyroiditis. Immunology 1968. link

    Original source

    1. [1]
      Current Practices in Hashimoto’s Thyroiditis: Differences in Attitudes Between Pediatric and Adult Endocrinologists in Türkiye: A National Survey. — Yeşiltepe Mutlu G, Özcabı B, Sağsak E, Dağdeviren Çakır A, Özer Y, Kara C Journal of clinical research in pediatric endocrinology (2025)
    2. [2]
      Effects of different supplements on Hashimoto's thyroiditis: a systematic review and network meta-analysis. — Peng B, Wang W, Gu Q, Wang P, Teng W, Shan Z Frontiers in endocrinology (2024)
    3. [3]
      Herbal medicine for Hashimoto's thyroiditis: A systematic review and network meta-analysis. — Luo J, Zhou L, Sun A, Yang H, Zhang P, Liu K et al. Journal of ethnopharmacology (2024)
    4. [4]
      Subacute thyroiditis: a rare presentation in pregnancy. — Gokkaya N Endokrynologia Polska (2024)
    5. [5]
      Assessment of Vitamin Concentrations in Patients with Hashimoto's Thyroiditis and Their Relationships with Thyroid Function, Biochemical Status, and Anthropometric Parameters-A Preliminary Study. — Mikulska-Sauermann AA, Resztak M, Karaźniewicz-Łada M, Filipowicz D, Ruchała M, Główka FK Nutrients (2024)
    6. [6]
      Effects of vitamin D supplementation on autoantibodies and thyroid function in patients with Hashimoto's thyroiditis: A systematic review and meta-analysis. — Tang J, Shan S, Li F, Yun P Medicine (2023)
    7. [7]
      Impact of Vitamin D on Immunopathology of Hashimoto's Thyroiditis: From Theory to Practice. — Lebiedziński F, Lisowska KA Nutrients (2023)
    8. [8]
      Cancer Risk in Hashimoto's Thyroiditis: a Systematic Review and Meta-Analysis. — Hu X, Wang X, Liang Y, Chen X, Zhou S, Fei W et al. Frontiers in endocrinology (2022)
    9. [9]
      Local symptoms of Hashimoto's thyroiditis: A systematic review. — Yuan J, Qi S, Zhang X, Lai H, Li X, Xiaoheng C et al. Frontiers in endocrinology (2022)
    10. [10]
      Metabolic Characteristics of Hashimoto's Thyroiditis Patients and the Role of Microelements and Diet in the Disease Management-An Overview. — Mikulska AA, Karaźniewicz-Łada M, Filipowicz D, Ruchała M, Główka FK International journal of molecular sciences (2022)
    11. [11]
      Riedel's thyroiditis - difficulties in differentiating from thyroid cancer. — Góralska M, Podlewska M, Żach M Endokrynologia Polska (2021)
    12. [12]
      An update on the pathogenesis of Hashimoto's thyroiditis. — Weetman AP Journal of endocrinological investigation (2021)
    13. [13]
      Vitamin D status in Hashimoto's thyroiditis and its association with vitamin D receptor genetic variants. — Hanna HWZ, Rizzo C, Abdel Halim RM, El Haddad HE, Salam R, El-Sayed Abou-Youssef H The Journal of steroid biochemistry and molecular biology (2021)
    14. [14]
      Twin sisters with Hashimoto's thyroiditis and Henoch-Schönlein purpura. — Wang XL, Wang YX, Liu M, Cheng Y, He XJ, Zhang YL Endokrynologia Polska (2020)
    15. [15]
      Acute suppurative thyroiditis with thyroid metastasis from oesophageal cancer. — Dai L, Lin S, Liu D, Wang Q Endokrynologia Polska (2020)
    16. [16]
      Prevalence of undifferentiated inflammatory arthropathy in patients with Hashimoto's thyroiditis in an endocrinology clinic. — Valderrama-Hinds LM, García-Carrión E, Hernández E, Agostini MI, Reyes-Morales OR, Fung L et al. International journal of rheumatic diseases (2019)
    17. [17]
      Case Series: Minocycline-Associated Thyroiditis. — Millington K, Charrow A, Smith J Hormone research in paediatrics (2019)
    18. [18]
      The effect of vitamin D on thyroid autoimmunity in euthyroid men with autoimmune thyroiditis and testosterone deficiency. — Krysiak R, Kowalcze K, Okopień B Pharmacological reports : PR (2019)
    19. [19]
      Thyroiditis and immune check point inhibitors: the post-marketing experience using the French National Pharmacovigilance database. — Garon-Czmil J, Petitpain N, Rouby F, Sassier M, Babai S, Yelehe-Okouma M et al. Fundamental & clinical pharmacology (2019)
    20. [20]
      The changing scene in Hashimoto's disease: a review. — Stuart A Medical hypotheses (2011)
    21. [21]
      Drug-induced thyroiditis and papillary carcinoma in a minocycline-pigmented black thyroid gland. — Tacon L, Tan CT, Alvarado R, Gill AJ, Sywak M, Fulcher G Thyroid : official journal of the American Thyroid Association (2008)
    22. [22]
      Painful Hashimoto's thyroiditis as an indication for thyroidectomy: clinical characteristics and outcome in seven patients. — Kon YC, DeGroot LJ The Journal of clinical endocrinology and metabolism (2003)
    23. [23]
      Typhoid thyroiditis. — Jasmi AY, Rohaizak, Meah FA, Sulaiman BT The Medical journal of Malaysia (1998)
    24. [24]
      Lymphocytic thyroiditis presenting as a unilateral painful goitre. — Sulimani RA East African medical journal (1997)
    25. [25]
      Riedel's thyroiditis complicated by hypoparathyroidism and hypothyroidism. — McRorie ER, Chalmers J, Campbell IW Scottish medical journal (1993)
    26. [26]
      Thyroiditis due to Brucella melitensis--report of two cases. — von Graevenitz A, Colla F Infection (1990)
    27. [27]
      Suppurative Staphylococcus aureus thyroiditis. — Evengård B, Julander I Scandinavian journal of infectious diseases (1986)
    28. [28]
      Management of a case of chronic radiodermatitis on the forehead. — Field LM The Journal of dermatologic surgery and oncology (1981)
    29. [29]
      Acute suppurative thyroiditis. A case report. — Millar AJ South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (1980)
    30. [30]
      "Silent" thyroiditis with symptomatic hyperthyroidism in an elderly patient. — Gordon M Journal of the American Geriatrics Society (1978)
    31. [31]
      Orbital involvement in Riedel's struma. — Schneider RJ Canadian journal of ophthalmology. Journal canadien d'ophtalmologie (1976)
    32. [32]
      Immunochemical studies on the thyroglobulin autoantibody system in human thyroiditis. — Roitt IM, Torrigiani G, Doniach D Immunology (1968)
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