Therapeutic target
- Establishment of a euthyroid metabolic state (= thyroid values in the normal range).
Therapy recommendations
- T4 substitution; indications for therapy:
- Manifest hypothyroidism (underactive thyroid) or TSH level ↑ to > 8-10 µU/ml or
- 5- to 10-fold increase in TPO antibodies.
- Latent hypothyroidism + markedly elevated TPO antibodies (therapy may be considered).
- In hyperthyroidism (hyperthyroidism) due to severe inflammation: administration of a noncardioselective beta-blocker such as propanolol [thyrostatic drugs (drugs that inhibit thyroid function) are not indicated].
- Iodide is contraindicated in autoimmune thyroiditis of the Hashimoto type! (However, iodine administration is required in pregnancy! (see below)
- Please note the instructions for selenium supplementation (see below).
- Pregnancy and autoimmune thyroiditis (see below).
Selenium supplementation
Recent studies point to inadequate selenium supply as a risk factor for the manifestation of Hashimoto’s thyroiditis. It has also been demonstrated that improving selenium intake can favorably influence the course of the disease. A daily intake of 200 µg of selenium leads to a decrease in TPO antibodies (= marker of disease activity) by approximately 36% after 3 months
- Mode of action: Selenium is a building block of deiodases, which deiodinate the prohormone thyroxine (T4) to the active hormone triiodothyronine (T3). With insufficient selenium supply increases the ratio of T4 to T3 in the serum.
Pregnancy and autoimmune thyroiditis
In the presence of Hashimoto’s autoimmune thyroiditis with hypothyroidism, the supply of iodine to the child is not guaranteed. These patients should take iodine, even at the risk of possibly developing hyperthyroidism or worsening inflammation. The iodine supply to the unborn child is more important in this case. Whether Hashimoto’s autoimmune thyroiditis worsens with iodine therapy can be detected by determining MAK or TPO-Ak levels. In addition, thyroid hormone levels (thyroxine (tetraiodothyronine, T4), triiodothyronine (T3)) should be determined approximately every 3 months.
Note: TSH target range 05-1.5 mU/L and 100 µg iodide no later than 12 weeks’ gestation until the end of breastfeeding (review dosing every 3 months).
