Lymphocytic Thyroiditis
Subtypes, Causes, Prognosis, and Coping
Medically reviewed by Danielle Weiss, MD
Lymphocytic thyroiditis is an autoimmune disease in which immune cells attack the thyroid gland and affect the production of thyroid hormones.
Lymphocytic thyroiditis initially causes an increase in thyroid hormones (hyperthyroidism) when the gland is first attacked, followed by an eventual drop in thyroid hormones (hypothyroidism) as the thyroid gland is injured. The drop in hormones can lead to symptoms such as fatigue, weight gain, irregular periods, cold sensitivity, dry skin, and an enlarged thyroid gland (called a goiter).
There are two types of lymphocytic thyroiditis: subacute lymphocytic thyroiditis (also known as silent or painless thyroiditis) and Hashimoto's disease (also known as chronic lymphocytic thyroiditis).
This article describes the causes and symptoms of the different subtypes of lymphocytic thyroiditis, including how they are diagnosed and treated. It also offers advice on when to see a healthcare provider and how to cope if diagnosed with this form of thyroid disease.
Subacute Lymphocytic Thyroiditis
Subacute lymphocytic thyroiditis, also known as painless thyroiditis or silent thyroiditis, is a self-limiting form of the disease most often seen in people assigned female at birth. It is called subacute because the condition doesn't develop or resolve as quickly as an acute disease or persist or recur like a chronic disease.
Subacute lymphocytic thyroiditis is caused by immune cells called antithyroid antibodies that target the thyroid gland with inflammation. The inflammation causes the thyroid gland to swell and affects how it works.
Subacute lymphocytic thyroiditis occurs in three phases:
Hyperthyroidism: This occurs when the thyroid gland is targeted with inflammation, causing it to overproduce thyroid hormones.
Hypothyroidism: This is when persistent inflammation causes injury to the thyroid gland, reducing its ability to produce thyroid hormones.
Euthyroidism: This is when the autoimmune assault ceases and the function of the thyroid gland normalizes.
The duration of phases can vary but tend to last between two and three months.
Postpartum Thyroiditis
Subacute lymphocytic thyroiditis is common following the birth of a child. The condition, sometimes referred to as postpartum thyroiditis, affects between 5% and 10% of pregnant people and typically causes symptoms within 12 to 16 weeks of birth.
As with other types of lymphocytic thyroiditis, postpartum thyroiditis postpartum involves the presence of antithyroid antibodies,
Symptoms
The symptoms of subacute lymphocytic thyroiditis tend to be milder than Hashimoto's disease. Per its nickname, the condition is generally painless with no signs of thyroid tenderness.
Symptoms differ by the phase of the disease:
Hyperthyroid Symptoms
Goiter, typically painless
Fatigue
Heat intolerance
Increased appetite
Increased sweating
Irregular menstrual periods
Irritability
Muscle cramps
Shakiness and restlessness
Heart palpitations
Weight loss
Frequent bowel movements
Hypothyroid Symptoms
Goiter, typically painless
Fatigue
Cold intolerance
Dry skin
Weight gain
Constipation
It is uncommon for subacute thyroiditis to become chronic.
Diagnosis
Subacute lymphocytic thyroiditis frequently goes undiagnosed. When a diagnosis is made, it typically occurs when hypothyroid symptoms develop.
The diagnosis is made with a physical exam, a review of your symptoms, and blood tests of your thyroid hormone levels.
While blood tests like a C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) may show signs of inflammation, blood for antithyroid antibodies will often be negative in people with subacute thyroiditis.
In such cases, a simple test called radioactive iodine uptake (RAIU) can determine if you are hyperthyroid or hypothyroid based on how much (or little) iodine is taken up by the thyroid gland.
Treatment
Treatment varies by the phase of the disease. If symptoms are mild, no treatment may be needed.
During the hyperthyroid phase, a beta-blocker may be prescribed to manage symptoms like palpitations, shakiness, anxiety, and heat intolerance.
During the hypothyroidism phase, a hormone replacement drug called Synthroid (levothyroxine) is commonly prescribed to boost hormone levels. Treatment lasts for at least a few months, at which point the drug is stopped and your thyroid hormones are retested in five weeks to confirm that no further treatment is needed.
Hashimoto's Disease
Hashimoto's disease (also known as Hashimoto's thyroiditis, autoimmune hypothyroidism, or chronic lymphocytic thyroiditis) is a long-lasting form of the disease. it is the most common cause of hypothyroidism in the United States, mainly affecting people assigned female at birth.
Hashimoto's disease is caused by the same autoimmune antibodies as subacute lymphocytic thyroiditis, but the production of these antibodies is persistent and doesn't resolve. The reason for this is unknown, although environmental and genetic factors are thought to play a part.
Symptoms
As with subacute lymphocytic thyroiditis, Hashimoto's first causes hyperthyroidism as a goiter develops, after which hypothyroidism will occur as the thyroid gland is progressively damaged. Over time, the goiter may shrink as significant damage is incurred.
Hashimoto's disease generally causes more overt symptoms than subacute lymphocytic thyroiditis in both phases of the disease:
Hyperthyroid Symptoms
Goiter, sometimes tender
Thyroid nodules
Anxiety
Difficulty concentrating
Fatigue
Frequent bowel movements
Hair loss
Hand tremor
Heat intolerance
Increased appetite
Increased sweating
Irregular periods
Nail changes
Nervousness or restlessness
Palpitations
Sleep problems
Weight loss
Hypothyroid Symptoms
Goiter that may eventually shrink and disappear
Constipation
Cold intolerance
Fatigue
Weakness
Irregular periods
Joint or muscle pain
Pale or dry skin
Depression
Hair loss
Brittle nails
Thinning eyebrows
Weight gain
Reduced taste and smell
Hoarseness
Facial puffiness
Swollen hands and feet
Slow speech
Thickening skin
Slowed heart rate
Related: Symptoms of Hashimoto's Disease
Diagnosis
Your healthcare provider will perform a physical exam including palpation (touching) of your thyroid to check for a goiter or nodules. A complete history will be taken, noting current symptoms as well as any family history of Hashimoto's disease.
If lymphocytic thyroiditis is suspected, blood tests will be ordered including thyroid hormones, CRP, ESR, and thyroid antibodies. Unlike subacute thyroiditis, autoimmune antibodies are more likely to be detected with Hashimoto's
Ultrasound or other medical imaging tests may be ordered to evaluate the size of the goiter and determine the appropriate course of treatment. RAIU may also be part of the diagnostic work-up.
Related: How Hashimoto's Disease Is Diagnosed
Treatment
The treatment of Hashimoto's disease is focused on normalizing thyroid hormone levels. Synthroid (levothyroxine) is the treatment of choice. Your thyroid hormone levels will need to be checked periodically to ensure that you are on the correct dose.
In rare cases, large goiters can make it difficult to swallow or breathe normally. In such cases, they can be removed surgically. Small goiters require no treatment and may resolve on their own once hormone levels are normalized.
Related: How Hashimoto's Disease Is Treated
When to See a Healthcare Provider
Lymphocytic thyroiditis can be difficult to spot early in the disease because the symptoms are often non-specific and can occur with any number of other conditions. However, thyroid disease should be considered if you have the following symptoms you cannot explain:
A lump or swelling at the front of the neck
Constant tiredness and fatigue
Sudden and significant weight gain
Dry skin
Facial puffiness
Brittle hair or nails
Feeling constantly anxious or depressed
Constantly feeling too hot or too cold
Prognosis of Lymphocytic Thyroiditis
While most people achieve a complete recovery from subacute lymphocytic thyroiditis, some people may experience recurrence every few years. Hashimoto's disease is a lifelong condition.
The good news is that with appropriate treatment your thyroid levels can return to normal and your symptoms may completely subside. You will likely have to take a thyroid replacement medication indefinitely and have your blood work checked every now and again to make sure you are on the proper dose of medication.
Coping With Lymphocytic Thyroiditis
Finding the right healthcare provider to help manage symptoms of lymphocytic thyroiditis is imperative when it comes to coping with the disease.
Coping can be especially difficult since thyroiditis can often lead to mood disorders such as depression. It is important to discuss these symptoms with your healthcare provider and to realize that they often resolve with appropriate treatment.
It may be helpful to join a support group and to be open about your feelings with family and friends. Do not hesitate to seek professional help when necessary.
Fatigue
Fatigue is another common symptom to cope with. You may need to reduce the demands on your time and reduce your expectations of things you are able to accomplish in a day in order to cope with a reduced energy level until your thyroid levels normalize.
It will be helpful to practice good sleep habits and reduce your caffeine intake in the meantime (caffeine can reduce your quality of sleep leading to even greater fatigue).
Weight Gain
Coping with weight gain related to thyroiditis can also be especially challenging, particularly for women. This can take time to achieve, however. In the meantime, continue eating a healthy diet and exercise on a regular basis.
Exercise can not only be helpful in managing weight but in managing other symptoms such as depression and constipation. Thyroid replacement alone does not lead to weight loss unless it's followed by a balanced diet and exercise.
Summary
Lymphocytic thyroiditis is an autoimmune disorder affecting the thyroid gland. The autoimmune assault initially causes hyperthyroidism (overactive thyroid) followed by hypothyroidism (underactive thyroid) when the thyroid gland is injured and less able to produce thyroid hormones.
There are two main types of the disease. Subacute lymphocytic thyroiditis is a self-limiting condition with milder symptoms that will often right itself after several months. Hashimoto's disease (a.k.a. chronic lymphocytic thyroiditis) is a permanent condition that doesn't right itself and causes life-long hypothyroidism.
Read the original article on Verywell Health.
