Radiation-Induced Thyroiditis

Aka: Radiation-Induced Thyroiditis

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II. Definition

  1. Acute Thyroiditis due to neck radiation

III. Epidemiology: Incidence

  1. Occurs in 1% of patients on I-131 for Hyperthyroidism

IV. Causes

  1. Radioiodine therapy (I-131) for Hyperthyroidism
  2. Head and neck radiation for Lymphoma
    1. High dose irradiation
    2. Pre-existing Hypothyroidism
    3. Younger women

V. Symptoms

  1. Anterior Neck Pain or Thyroid pain
    1. Onset in first 1-2 weeks after I-131 or other neck Radiation Therapy

VI. Signs

  1. Thyroid tenderness to palpation
  2. Thyroid Gland enlargement

VII. Labs

  1. Thyroid Function Tests (TSH, T4 Free)
    1. Hyperthyroidism surges temporarily

VIII. Management

  1. Thyroid Pain
    1. NSAIDs
    2. Prednisone if refractory to NSAIDs (rarely needed)
      1. Short course at 40-60 mg orally daily with taper
  2. Hyperthyroidism symptoms
    1. Beta Blocker (e.g. Propranolol)

IX. Course

  1. Resolves in 6-18 weeks (typically by 4 weeks) as Thyroid fibrosis occurs

X. References

  1. Bindra (2006) Am Fam Physician 73:1769-76 [PubMed]
  2. Jereczek (2004) Cancer Treat Rev 30:369-84 [PubMed]
  3. Quintero (2021) Am Fam Physician 104(6): 609-17 [PubMed]

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