Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
While the provided UK guidelines do not specifically detail follow-up strategies for 'thyroiditis' as a standalone diagnosis, they outline comprehensive monitoring for conditions that can arise from or be associated with thyroiditis, such as hyperthyroidism, hypothyroidism, and complications of their treatments NICE CKS,NICE NG145.
Monitoring for Hyperthyroidism and its Treatments:- Antithyroid Drugs (Carbimazole, Propylthiouracil):
- Before starting treatment, a full blood count (FBC) including white cell count and differential, and liver function tests (LFTs) should be checked NICE CKS,NICE NG145.
- Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) should be measured every 6 weeks until TSH is within the reference range NICE CKS,NICE NG145.
- Subsequently, TSH (with cascading to check FT4 and FT3) should be measured every 3 months until antithyroid drugs are stopped NICE CKS,NICE NG145.
- Do not routinely monitor FBC and LFTs unless there is a clinical suspicion of agranulocytosis or liver damage NICE CKS,NICE NG145.
- After stopping antithyroid drugs, TSH (with cascading) should be checked within 8 weeks, then every 3 months for a year, and then once a year NICE CKS,NICE NG145.
- Radioactive Iodine Treatment:
- TSH, FT4, and FT3 levels should be measured every 6 weeks for the first 6 months after treatment until TSH is within the reference range NICE CKS,NICE NG145.
- If the person remains biochemically euthyroid at 6 months, consider measuring TSH (with cascading) at 9 and 12 months after treatment NICE CKS,NICE NG145.
- If euthyroid at 12 months, consider measuring TSH (with cascading) every 6 months unless hypothyroidism develops NICE CKS,NICE NG145.
- Specialist follow-up is needed as levothyroxine (LT4) replacement therapy may be required if hypothyroidism occurs NICE CKS.
- Thyroid Surgery (Total Thyroidectomy):
- Levothyroxine (LT4) replacement therapy will be started post-operatively, and monitoring for hypothyroidism should follow relevant guidelines NICE CKS,NICE NG145.
- Thyroid Surgery (Hemithyroidectomy):
- TSH may be measured (with cascading) annually, depending on specialist advice NICE CKS,NICE NG145.
- Untreated Subclinical Hyperthyroidism:
- Consider measuring TSH every 6 months NICE CKS,NICE NG145.
- If TSH is outside the reference range, consider measuring FT4 and FT3 in the same sample NICE CKS,NICE NG145.
- Consider stopping TSH monitoring if the TSH level stabilises (2 similar measurements within the reference range 3 to 6 months apart) NICE CKS,NICE NG145.
- Untreated Subclinical Hypothyroidism:
- For adults with a TSH above the reference range but lower than 10 mlU/litre on two separate occasions 3 months apart, and symptoms of hypothyroidism, a 6-month trial of levothyroxine may be considered NICE NG145.
- If symptoms do not improve or persist when serum TSH is within the reference range, consider stopping levothyroxine and monitor untreated subclinical hypothyroidism NICE NG145.
- Levothyroxine (LT4) Therapy:
- Once the TSH level is stable (2 similar measurements within the reference range 3 months apart), check TSH annually NICE CKS.
- If TFTs remain abnormal or symptoms persist despite adequate LT4 doses, assess for non-compliance, drug interactions, gastrointestinal malabsorption, or simultaneous intake with interfering foods/drinks NICE CKS.
- Educate patients about important drug adverse effects and symptoms, and the need to stop the offending drug immediately if suspected NICE CKS.
- If agranulocytosis is suspected, stop and do not restart any antithyroid drugs, and consider referral to a specialist NICE CKS,NICE NG145.
- Hepatotoxicity usually develops within 3 months of starting propylthiouracil NICE CKS.