Published February 9 2015
Although most people who present with a hyperthyroid condition have Graves’ Disease, some people have what’s called subacute thyroiditis. This is an inflammatory condition of the thyroid, and in most cases this doesn’t involve an autoimmune component. The good news is that unlike Graves’ disease, subacute thyroiditis usually resolves on its own, although it may take a few months. However, while it’s active the person can have severe hyperthyroid symptoms which need to be managed. Although prescription drugs such as beta blockers are commonly recommended, some people with subacute thyroiditis have asked me if following a natural treatment protocol can benefit them.
There are a few different types of subacute thyroiditis. Subacute granulomatous thyroiditis is painful, whereas subacute lymphocytic thyroiditis typically doesn’t involve any pain, and is often mistaken for Graves’ Disease. What happens with each of these conditions is that inflammation damages thyroid follicles and large amounts of thyroid hormones are released into the circulation, resulting in clinical and biochemical thyrotoxicosis (1). This state is temporary, as the synthesis of thyroid hormone decreases due to the damage to the thyroid cells (1).
Subacute thyroiditis is thought to be caused by a viral infection of the thyroid gland (2). The condition often occurs after a viral infection of the upper respiratory tract (2). The hyperthyroid condition can last from a few weeks to a few months, and is commonly followed by a period of hypothyroidism that can last six months or longer. Some people with subacute thyroiditis eventually develop permanent hypothyroidism, although this isn’t too common (2) (3).
How Subacute Thyroiditis Is Differentiated From Graves’ Disease
Graves’ Disease is characterized by elevated TSH receptor antibodies. In addition, a radioactive iodine uptake scan is typically elevated in people with Graves’ Disease. On the other hand, with subacute thyroiditis, the TSH receptor antibodies will usually be negative, and the radioactive iodine uptake test will be low. In addition, a high erythrocyte sedimentation rate (ESR) is usually present in subacute thyroiditis. The ESR may or may not be elevated in Graves’ Disease.
I’m personally not a big fan of the radioactive iodine uptake test, as I discussed in an article entitled “What You Need To Know About the Radioactive Iodine Uptake Test“. And so what I usually recommend is to first have the TSH receptor/TSI antibodies tested. If these are elevated then this confirms the presence of Graves’ Disease, and in most cases doing a radioactive iodine uptake test isn’t necessary. On the other hand, if these antibodies are negative this doesn’t necessarily rule out Graves’ Disease. As I mentioned earlier, the ESR is usually elevated in subacute thyroiditis, but it can also be elevated in Graves’ Disease. As a result, if someone has negative TSI antibodies and an elevated ESR, there is a good chance they have subacute thyroiditis, but there is still a chance they might have Graves’ Disease. And so this is one scenario when getting a radioactive iodine uptake scan might be a good idea, although another option is just to manage the hyperthyroid symptoms for a few months and see if it resolves, which is the case with subactue thyroiditis, but usually isn’t the case with Graves’ Disease.
Another thing to look out for are eye symptoms, which are associated with many cases of Graves’ Disease, but usually isn’t a factor with subacute thyroiditis. If someone has a negative test for TSI antibodies, a positive ESR, and has symptoms of thyroid eye disease such as swelling or bulging eyes, then Graves’ Disease needs to be suspected. This is true even if the TSI antibodies are negative, as while positive TSI antibodies confirm that someone has Graves’ Disease, negative TSI antibodies don’t rule out this autoimmune thyroid condition. Often times taking a thorough case history and running a few simple tests can help to differentiate Graves’ Disease from subacute thyroiditis without the need to do a radioactive iodine uptake test.
While there seems to be a genetic component to Graves’ Disease, the same is probably true with subacute thyroiditis. Human leukocyte antigen (HLA)-B35 seems to be associated with this condition (4) (5) (6). I mentioned earlier how a viral infection is probably responsible for this condition, and so those people with the HLA-B35 marker who are exposed to this viral infection have a greater likelihood of developing subacute thyroiditis. Some of the viruses associated with subacute thyroiditis include measles, mumps, influenza, enterovirus Epstein-barr, adenovirus, echovirus, and St Louis encephalitis (7). Rubella (German measles) can also be a potential trigger (8).
Can People With Subacute Thyroiditis Benefit From Natural Treatment Methods?
Just as is the case with Graves’ Disease, many people with subacute thyroiditis can have their hyperthyroid symptoms managed naturally with herbs such as bugleweed, motherwort, and lemon balm. However, since this condition usually self-resolves, most people with subacute thyroiditis won’t need to follow a prolonged natural treatment protocol. Since most of the cases are viral induced, in addition to doing things to manage the hyperthyroid symptoms they can also take natural anti-viral herbs and nutrients such as olive leaf extract (9) (10), St. John’s Wort (11) (12), zinc (13) (14), vitamin C (15), and propolis (16) (17), and it would also be a good idea to do other things to help improve the health of the immune system.
With regards to improving immune system health, many people with subacute thyroiditis might figure that this isn’t necessary since the condition will usually resolve on its own. However, I’ve known some people who had a second occurrence of this condition. Plus, if someone has a weakened immune system they will be more susceptible to developing other health conditions as well. So while someone with subacute thyroiditis probably won’t need to follow an autoimmune paleo diet, they still will want to eat healthy, minimize their consumption of refined foods and sugars, improve their stress handling skills, make sure they have healthy vitamin D levels, etc. Truth to be told, anyone with any type of serious infection should do things to improve their immune system health in order to prevent a future reoccurrence.
Another thing to keep in mind is that because hypothyroidism commonly follows subacute thyroiditis, if someone is taking higher doses of natural antithyroid herbs such as bugleweed, then this of course can make them even more hypothyroid. This is one reason why many medical doctors will give beta blockers instead of antithyroid medication, as the beta blockers will reduce the elevated heart rate and palpitations without affecting the thyroid hormone levels. The good news is that if someone with subacute thyroiditis is taking antithyroid medication or herbs and becomes hypothyroid, stopping these antithyroid agents should help to increase the thyroid hormone levels. However, because the hypothyroidism probably would have happened regardless of whether the person was taking these agents, the person might still remain hypothyroid for a few months, even after stopping antithyroid medication or herbs.
In summary, subacute thyroiditis needs to be considered when someone initially presents with hyperthyroid symptoms. This usually presents with negative TSI antibodies, a positive ESR, and it may or may not involve neck pain. If a radioactive iodine uptake test is conducted it is usually low in subacute thyroiditis, and is usually elevated in Graves’ Disease. A viral infection of the thyroid gland seems to be the cause of most cases of subacute thyroiditis. This usually causes temporary hyperthyroidism, and in most cases it is followed by temporary hypothyroidism. Although most people with subacute thyroiditis don’t need to follow an extended natural treatment protocol, they still need to do things to manage the hyperthyroid symptoms, and will also want to improve their immune system health in order to prevent a reoccurrence of the condition, as well as prevent other future health issues in the future.
