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What Is The Difference Between Acute Thyroiditis From Viral Infection And Hashimotos?

Posted on Thu, 23 Jan 2014

Question: Hello Doctor. I was diagnosed with Hashimotos last month, following a viral infection. What is the difference between acute Thyroiditis from viral infection and Hashi's? Is it possible to recover from Thyroiditis if the antibodies go down? Perhaps it is not permanent?

Answered by Dr. Shehzad Topiwala (2 hours later)

Brief Answer: Thyroid Detailed Answer: You are correct in your impressions about this complex condition. Thyroiditis can be temporary from various causes such as viral infection. There are several types such as silent (painless) to subacute (or painful), to name a couple. These have a typical tendency to recover to normal after a few months. However this requires due vigilance by an endocrinologist to observe the evolution of the condition. Periodic testing of thyroid function in the form of labs like TSH and free T4 are extremely helpful is assessing the thyroid status at that point in time. Sometimes, the thyroid goes back to under-activity after a phase of apparent normalcy. Hence a certain degree of finesse is required to correctly diagnose this condition. Hashimoto's on the other hand is typically permanent and necessitates lifelong thyroid medication. Anti TPO and / or Thyroglobulin antibodies are often positive in this situation. There is usually a family history of the same, and quite often an enlarged thyroid too.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (49 minutes later)

Sorry for the delay in my follow up question. Yes, my antibodies were in the two thousand range. However, my thyroid was neither enlarged, nor with significant nodules. The only reason I went to see the doctor is because it was extremely tender and painful, which is why I was thinking it may be the subacute variety, and therefore temporary ( although recovery is taking several months). I have also read that antibodies can occur during this kind of thyroiditis, as well as Hashi's. I am being closely monitored with tests to evaluate the course of this. I was hoping that even with such high antibodies, it was still only the subacute variety and that there may be a chance my thyroid would retrun to normal. May I please ask this one more thing...when my antibodies are attacking my thyroid, is part of the unwell feeling due to the "die-off" of the cells or something? Could you explain this to me? I will be happy to pay extra for your time and care in response. I am trying to understand so much that is new to me, and the illness is very different from anything I've ever experienced before. Thank you, sincerely.

Answered by Dr. Shehzad Topiwala (23 hours later)

Brief Answer: Follow up Detailed Answer: I commend your understanding of this complex subject. Yes, antibodies can be positive in either variety although greater association with the auto-immune condition that the post-viral. Generally the auto-immune kind does not cause a generalized ill-feeling as it a silent immune mediated destruction of the thyroid cells. Although this may sound like an aggressive situation it really is without major symptoms. The chances of permanent hypothyroidism are greater with this type of thyroiditis, versus the temporary painful post-infectious type that often recovers to normal. So the best way to handle this is to closely watch this in the ensuing months to observe where it goes and settles.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (2 hours later)

Hello Dr. Topiwala, Thank you for answering my question. I have this last follow-up, then will close discussion for now. Is it advisable to take levo thyroxine during the crisis of subacute thyroiditis? I have read it may help symptoms as well as prevent it becoming hypothyroid after the illness abates. It is helping me, though a very small dose .25. I have more questions, but in fairness, will open up a new dialogue/question tomorrow. Thank you. XXXX

Answered by Dr. Shehzad Topiwala (4 minutes later)

Brief Answer: Yes Detailed Answer: Yes one can consider the use of levothyroxine temporarily. However, this requires careful analysis of the trend of thyroid function. This requires interpretation of labs by a thyroid expert in conjunction with your symptoms.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar