Have you been noticing changes in your mood, skin, weight and energy levels? Your symptoms could be down to inflammation of your thyroid gland, known as thyroiditis.
Thyroiditis can be a tricky condition to diagnose and cope with – there are several different types and causes, plus the symptoms are often very individual, and could also be due to something else.
It can be worrying and frustrating to feel it might take some detective work to get to the right treatment for you.
But the good news is that thyroiditis can be effectively managed and treated. And while some types will need long-term or permanent treatment, other types can go away within 12 to 18 months.
This guide will point you in the right direction to get a diagnosis and treatment, so you can deal with your symptoms and get on with enjoying life.
What is thyroiditis?
Thyroiditis is inflammation of your thyroid gland – a butterfly-shaped gland in your neck.
Your thyroid gland makes hormones that help your body stay warm and keep your brain, heart, muscles and other organs working properly. So if it isn’t functioning normally, it can affect many parts of your body and its processes.
What are the symptoms of thyroiditis?
When your thyroid gland is inflamed, it can become ‘overactive’ – when it makes too much thyroid hormone – or ‘underactive’ – when it doesn't make enough. Depending on the type of thyroiditis you have (see below), you may go through phases of both.
What symptoms you have will be unique to you – there are no set symptoms that happen to everyone with thyroiditis.
But if you have an overactive thyroid (hyperthyroidism), typical symptoms include:
- weight loss
- feeling nervous, anxious or irritable
- trouble sleeping (insomnia)
- a fast heart rate or palpitations
- muscle weakness
- shaking of the hands or fingers (tremor)
If you have an underactive thyroid (hypothyroidism), typical symptoms include:
Thyroiditis can also cause swelling of the thyroid gland, which may sometimes be painful.
If you’re worried about your symptoms, but not sure if you need to see a doctor, use the Healthily Smart Symptom Checker to help you work out your best next step.
Types of thyroiditis – causes and who gets them
There are several types of thyroiditis, which have different causes and can lead to different symptoms. Here’s what you need to know about each type.
Autoimmune thyroiditis happens when your body’s immune system attacks your thyroid gland cells as if they were foreign or ‘invading’ your body. There are several types, but Hashimoto’s thyroiditis is the most common.
Who gets it? It’s not clear why Hashimoto’s thyroiditis happens, but it’s much more common in women than men, and symptoms usually start when you’re 30 to 50 years old. It may also run in families.
What happens? Your immune system damages your thyroid gland and causes a slow destruction of the cells, so over months or years you develop an underactive thyroid. You may also have painless enlargement of your thyroid. Hashimoto’s can’t be cured, but it’s easily treated by taking a daily thyroid medicine called levothyroxine.
Painless or ‘silent’
Who gets it? Like Hashimoto’s, painless thyroiditis affects women more often than men, and can also run in families.
What happens? This type of autoimmune thyroiditis first causes an overactive thyroid, followed by an underactive thyroid. Your normal thyroid function usually comes back after 12 to 18 months, although there’s about a 20% chance of having a permanently underactive thyroid gland, which needs treatment with thyroid medicine.
Who gets it? This uncommon type of thyroiditis can happen after you’ve given birth. It’s more likely if you have type 1 diabetes or you’ve had thyroid problems before.
What happens? Symptoms of an overactive thyroid usually appear around 1 to 4 months after you’ve given birth. A few weeks after that, you get symptoms of an underactive thyroid. Not everyone goes through both phases. As with painless thyroiditis, it usually goes away within 12 to 18 months, but there’s a 20% chance of having permanent (but treatable) underactive thyroid.
Thyroiditis caused by infections
What happens? It’s a painful swelling of the thyroid gland, which often causes a high temperature (fever) and pain in the neck or jaw, followed by symptoms of an overactive thyroid. These settle after a few days, but are often followed by symptoms of an underactive thyroid. Recovery usually takes 12 to 18 months, with a 5% possibility of a permanent underactive thyroid that needs treatment.
Who gets it? This rare form of thyroiditis is more common in people with a weak immune system. It’s usually caused by a bacterial infection (although any infection may trigger it). In children, it’s often linked to a problem with the development of the thyroid gland.
What happens? Symptoms include feeling unwell, along with throat pain and a swollen thyroid gland, which may be underactive or overactive. The infection needs treatment with antibiotics, which usually makes symptoms go away.
Medically induced thyroiditis
Who gets it? People taking certain prescribed medications, including amiodarone (used for heart-rhythm problems and palpitations), lithium (used to treat bipolar disorder) and interferons (used to treat some cancers).
What happens? The medication damages your thyroid gland, causing symptoms of either overactive or underactive thyroid, and sometimes pain around your thyroid gland. Symptoms normally go away once you stop taking the medication. You should never stop taking a prescribed medicine without checking with your doctor if it’s safe to do so, as it may lead to side effects or a flare-up of your condition.
Who gets it? It can happen to people who’ve had treatment with radioactive iodine for an overactive thyroid, or external beam radiotherapy for certain cancers.
What happens? Damage to the thyroid gland can lead to symptoms of either underactive or – less commonly – overactive thyroid. If it causes overactive thyroid, this normally goes away within a month. But an underactive thyroid is usually permanent, so needs long-term treatment.
The 3 phases of thyroiditis
If you have thyroiditis, your symptoms and the timescale of how long they last will be unique to you, and depend on the type of thyroiditis you have.
But if you have painless or postpartum thyroiditis, there are often 3 phases:
- Overactive (thyrotoxic) – this phase can cause the typical symptoms of an overactive thyroid gland and last for 1 to 3 months.
- Underactive (hypothyroid) – this causes symptoms of an underactive thyroid gland and may last up to 9 to 12 months.
- Normal (euthyroid) – about 80% of people with painless or postpartum thyroiditis return to normal within 12 to 18 months of getting thyroiditis symptoms.
Can thyroiditis be prevented?
In most cases, thyroiditis can’t be prevented. If you have a health condition or are taking medication that could increase your risk, talk to your doctor for advice.
Living and coping with thyroiditis
We know that dealing with the symptoms of thyroiditis can affect your emotional health as well as your physical health. Read about supporting your wellbeing while living with thyroid problems.
When to see a doctor
You should see a doctor as soon as possible if:
- you have a fast heart rate or palpitations
- a swelling suddenly develops on your neck
- your thyroid gland becomes painful
- your skin or eyes turn yellow
- you’re losing weight without meaning to
- you’re finding it hard to do your daily activities
Get emergency medical help if you:
- have a very high or very low temperature, or other symptoms of sepsis(yourmd:/condition/blood-poisoning)
- feel confused, dizzy or faint
- have trouble breathing
How is thyroiditis diagnosed?
Your doctor will want to know about your symptoms and how they’ve been affecting you. To help them, you could track your symptoms before your appointment – try using the symptom trackers in the Healthily self-care app.
If your doctor suspects a thyroid problem, tests can help confirm it or rule it out, including:
- blood tests – to check if your level of thyroid hormone is too high or low. Blood tests can also measure your level of thyroid-stimulating hormone (TSH) – which can affect your thyroid hormone – and check for certain antibodies
- ultrasound scan – this can be used to look at your thyroid gland and see if it’s enlarged
- radioactive iodine uptake test – this specialist test measures your thyroid’s ability to absorb iodine, which is needed to make thyroid hormone
- biopsy – if a diagnosis isn’t clear, a tiny piece of your thyroid gland may be removed and examined to help work out what’s attacking it
If you’re diagnosed with thyroiditis, it can be helpful to ask your doctor these questions:
- what do the results of my blood tests mean?
- what type of thyroiditis do I have, and what’s the likely cause?
- do I need to take medicine – and if so, for how long? Are there any side effects?
- can I make any lifestyle or diet changes to help manage my symptoms or side effects of treatment?
How does a doctor treat thyroiditis?
The treatment you need will depend on the type of thyroiditis you have, but the options are the same as for overactive and underactive thyroid. Here’s what you need to know:
- overactive thyroid is normally treated with beta blockers to reduce tremors and slow down a fast heart rate. If the overactive phase of your thyroiditis is temporary, treatment will be gradually reduced and stopped as your symptoms improve
- underactive thyroid is treated with thyroid medicine such as levothyroxine – but you may not need treatment if you have very mild or no symptoms
- for thyroiditis that doesn’t cause permanent underactive thyroid, treatment is usually continued and monitored for 6 to12 months, then reduced and stopped as your thyroid gland recovers
- if you have thyroid pain (such as with subacute thyroiditis), this is usually managed with painkillers such as aspirin or ibuprofen. Severe thyroid pain can be treated with steroid tablets
- if you need to take a long-term daily dose of thyroid medicine, you’ll need regular blood tests to check the dose is right for you. At first – and while the dose is being adjusted – you’ll need a blood test every 4 to 12 weeks. Once you’re on the right dose, testing can be done once a year
Dr Roger Henderson says:
“You’ll get the best from your medicine if you take it as prescribed. It can be hard to get into a routine of taking your medicine, so try linking it to a habit you already have. For example, if you always have a hot drink in the morning, you could keep your medicine next to your tea bags or coffee. Or near your toothbrush, or on your bedside table. You could also set a reminder on your phone.”