The information in this website is intended only for healthcare professionals. By entering this site, you are confirming that you are a healthcare professional.
The information in this website is intended only for laboratory professionals. By entering this site, you are confirming that you are a laboratory professional.
Thyroid Diseases Patient Management
To diagnose patients you suspect of having an autoimmune thyroid disease (AITD), you will need to rely on input from multiple sources, including the findings of a detailed patient history, serological testing, and clinical observation. That data, along with the patient’s symptoms, can help you formulate a long-term management plan for him or her. A combination of specific drugs, or surgery may be explored alone or in combination for long term maintenance. Also like other autoimmune diseases, AITDs may vary in severity and manifestation, so it is important to tailor your patient’s management plan to achieve the best possible outcomes.
Well-established clinical guidelines can help facilitate the creation of a management plan that can then be personalized to meet that patient’s needs:
Prognosis
Long-term prognosis for patients with Hashimoto’s thyroiditis or Graves’ disease is generally considered excellent when the correct therapies are administered. 1
Without treatment, relapse is possible. Untreated or undermanaged AITDs pose several serious risks, including:
- Increased cardiovascular mortality, especially in patients over 40 years of age2
- Mental health issues, which can worsen over time3
- Myxedema, a rare condition that can develop as a result of Hashimoto’s thyroiditis being left untreated long term4
- Birth defects5
Comorbidities
Though AITD can be successfully managed, developing a plan to do so can be complicated by the patient’s comorbidities.
One of the first clues that multiple autoimmune diseases may be occurring is the continued or worsening of AITD symptoms. This may also point to disease progression. There is a particularly strong connection between AITD and celiac disease, which is thought to be partly due to a common genetic predisposition, and it is estimated that between 2-5% of people diagnosed with celiac disease also had AITD.12
A collection of tests exist that can help you identify AITD and coexisting autoimmune diseases, which can help you create the most comprehensive treatment plan possible.
It is important to consider the possibility of a patient having multiple other autoimmune conditions, as research has shown that patients with AITD have an increased risk for:
Celiac Disease (CD)
up to 20% of patients6
Systemic Lupus Erythematosus (SLE)
up to 6% of patients7
Sjögren’s Syndrome
37-50% of patients8
Rheumatoid Arthritis (RA)
up to 10% of patients9
Antiphospholipid Ayndrome (APS)
up to 5% of patients 10
Vasculitis
up to 20% of patients11
PRECISE MANAGEMENT - AN APPROACH UNIQUE TO EACH PATIENT
As is likely your standard practice, keeping an open line of communication with your patient about exercise, diet, and medications can help him or her to learn how best to manage the disease.
Once the diagnosis of an AITD is confirmed and decision for replacement therapy is made, the main treatment objective is to restore euthyroidism, improving symptoms and metabolic abnormalities associated with thyroid hormone deficiency.13
Tailoring this plan to the patient’s specific signs and symptoms can help achieve the best outcomes. Those outcomes should be focused on the reduction of symptoms, as AITDs are chronic and incurable. Though mild cases of an AITD may settle down spontaneously, ongoing tailored management is critical to maintaining improvement. Relapse occurs in around 30–50% of patients, despite the use of anti-thyroid drugs. If relapse occurs, AITDs may be treated using a combination of methods tailored to a patient's individual presentation.14
If your patient continues to exhibit symptoms (i.e., weight changes, chronic fatigue) despite treatment, you may want to consider that another autoimmune disease, especially CD, as a possible comorbidity. Women who are planning to become pregnant should be euthyroid before conception, and those with Graves' disease must be meticulously managed prior to conception and during the ensuing pregnancy.15
Follow-up examinations and subsequent testing may help identify any coexisting autoimmune diseases. This additional information is often helpful to the development of a management plan that can address the fuller scale of the patient’s health concerns.
Continued Testing and Monitoring
Patients receiving treatment for AITD may experience adverse reactions to selected therapies, and should be monitored for any negative clinical events.14
Continued surveillance of overlapping symptoms and clinical events in response to selected therapies may call for subsequent diagnostic testing. Diagnostic testing can help you identify coexisting autoimmune diseases. Knowledge of the existence of these diseases can help you establish the most encompassing, precise management strategy that controls symptoms, which can also keep AITD from being a risk factor for other diseases.
- Epocrates. Primary hyperthyroidism. https://online.epocrates.com/diseases/53551/Primary-hypothyroidism/Prognosis. Accessed December 2017.
- Boelaert K, Maisonneuve P, Torlinska B, et al. Comparison of mortality in hyperthyroidism during periods of treatment with thionamides and after radioiodine. J Clin Endocrinol Metab. 2013;98:1869-1882.
- Radhakrishnan R, Calvin S, Singh JK, Thomas B, Srinivasan K. Thyroid dysfunction in major psychiatric disorders in a hospital based sample. The Indian Journal of Medical Research. 2013;138(6):888-893.
- Nair PA, Mishra A, Chaudhary A. Pretibial Myxedema Associated with Euthyroid Hashimoto’s Thyroiditis: A Case Report. Journal of Clinical and Diagnostic Research : JCDR. 2014;8(6):YD01-YD02. doi:10.7860/JCDR/2014/6581.4415.
- Mayo Clinic. Hashimoto's Disease. https://www.mayoclinic.org/diseases-conditions/hashimotos-disease/symptoms-causes/syc-20351855. Accessed December 2017.
- Sun X, Lu L, Yang R, Li Y, Shan L, Wang Y. Increased Incidence of Thyroid Disease in Patients with Celiac Disease: A Systematic Review and Meta-Analysis. Sestak K, ed. PLoS ONE. 2016;11(12):e0168708.
- Appenzeller S1, Pallone AT, Natalin RA et al. Prevalence of thyroid dysfunction in systemic lupus erythematosus. J Clin Rheumatol. 2009;15(3):117-119.
- Pérez B, Kraus A, López G et al. Autoimmune thyroid disease in primary Sjögren's syndrome. Am J Med. 1995;99(5):480-484.
- Cárdenas Roldán J, Amaya-Amaya J, Castellanos-de la Hoz J et al. Autoimmune thyroid disease in rheumatoid arthritis: a global perspective. Arthritis. 2012;2012:864907.
- Versini M. Thyroid Autoimmunity and Antiphospholipid Syndrome: Not Such a Trivial Association. Frontiers in Endocrinology. 2017;8:175.
- Lionaki S, Hogan SL, Falk RJ at al. Association between thyroid disease and its treatment with ANCA small-vessel vasculitis: a case–control study. Nephrol Dial Transplant. 2007;22:3508-3515.
- Ch’ng CL, Jones MK, Kingham JGC. Celiac Disease and Autoimmune Thyroid Disease. Clin Med Res. 2007;5(3):184-192.
- Brenta, G. Clinical Practice Guidelines for the Management of Hypothyroidism. Arq Bras Endocrinol Metab. 2013;57:4
- Premawardhana LDKE, Lazarus JH. Management of thyroid disorders. Postgraduate Med J. 2006;82(971):552-558.
- Stagnaro-Green A, et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid. 2011;21:1081-1125.
© 2026 Thermo Fisher Scientific Inc. All Rights Reserved.