Background: Subacute thyroiditis is a self-limited inflammatory thyroid disorder with a triphasic clinical course of thyrotoxicosis, hypothyroidism, and return to euthyroidism. Whilst glucocorticoid (GC) treatment is advocated for managing moderate-to-severe symptoms, the ideal initiating dose and titration regime is unclear. Traditionally, doses of up to 40 mg of prednisolone have been used. More recently, to minimize adverse effects, a 15 mg initiation dose of prednisolone with a 2-weekly reducing regime by 5 mg has been described but with high disease relapse rates.
Aim: To assess safety and efficacy of our protocol of initiating oral prednisolone 30 mg daily (or equivalent dose of oral methylprednisolone) and reducing by 5 mg every 2 weeks until discontinued. Thyroid ultrasound examinations were also performed at baseline, at one and three months.
Methods: We prospectively collected data on all nine consecutive patients presenting with subacute thyroiditis where GC treatment was used as per our protocol from November 2015 to December 2016.
Results: Patients ranged from 33 to 65 years in age and included five women. Neck pain was seen in all patients; symptomatic improvement occurred within 2448 hrs of glucocorticoid treatment in all. Full resolution of symptoms with no recurrences was achieved in 7 patients (78%). Two patients suffered symptom recurrence when GC dose was reduced and required extended therapy (28.1 and 32.6 weeks). Two patients developed hypothyroidism requiring levothyroxine at six months. There was sonographic evidence of thyroiditis in all at baseline; following a month of therapy, inflammation had completely (50%) or partially (50%) resolved; only one patient had persistence of mild inflammatory appearances at three months. Side-effects were rare with mild abdominal discomfort in one participant and mild post-prandial hyperglycaemia in another participant.
Conclusion: Our protocol for GC treatment for moderate-to-severe subacute thyroiditis was safe and effective, achieving rapid clinical and sonographic resolution in the majority of patients.