Endocrine Abstracts

Subacute Thyroiditis (SAT) is a painful, self-limited inflammation of the thyroid gland. Guidelines recommend Non-Steroid Antiinflammatory Drugs (NSAIDs) for mild cases and steroids for moderate to severe cases. Early relapses can be seen in about 9-35%. The aim of this study was to investigate the clinical, laboratory, and imaging findings that may affect treatment selection and predict relapse.

Materials and Methods: Forty SAT patients who applied to the Endocrinology and Metabolic Diseases Department of Ankara University Hospitals between Jan. 2020 – Jan. 2021 were included prospectively. All patients were evaluated with Clinical Categorical Pain Scale; NSAIDs were administered for mild cases (0-1 points) and steroids (Methylprednisolone 32 mg) for moderate to severe cases or cases unresponsive to NSAIDs. After the response, the dosage of methylprednisolone was reduced by 4 mg per 3 days. Methylprednisolone was discontinued if remission was achieved following 10 days of the 4 mg dose. If symptoms increased during or after treatment and relapse was detected, the steroid dose was increased or restarted. NSAID and steroid treatment groups at baseline and patients with and without relapse during follow-up were compared in terms of clinical, biochemical, and imaging findings.

Results: 28 (70%) patients received a steroid regimen, and 12 (30%) patients received NSAIDs initially. In the steroid treatment group tenderness on palpation was more prominent (p:0,005), thyroid stimulating hormone (TSH) levels were lower (p:0.007), free T4 and free T3 levels were higher (p:0,003; 0,002), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were higher (P<0,001; 0,004), lymphocyte counts were lower significantly (P:0,046). The unresponsiveness to NSAIDs was 70%. The remission was achieved in 35 patients with methylprednisolone and in 2 patients with NSAIDs. Relapse was observed in 14 of 37 patients (37.8%). Only one of the relapsed patients had NSAIDs as the first-line treatment. Patients who relapsed (n=13) and did not relapse (n=22) in the steroid group were compared; ESR, and total thyroid gland volume were higher (p:0,012; 0,049) and the duration of successful treatment was longer (P<0.001) significantly in the relapsed group.

Conclusions: Steroids might be considered for the first-line treatment instead of NSAIDs in symptomatic patients due to the high unresponsiveness to NSAIDs. ESR and total thyroid volume might be parameters that may predict the relapse in the steroid treatment group. Slower steroid dose reduction particularly in patients with a high risk of relapse may be helpful to prevent relapse.

Keywords: Subacute Thyroiditis, Treatment, Relapse