An Evaluation of the Results of the Steroid and Non-steroidal Anti-inflammatory Drug Treatments in Subacute Thyroiditis in relation to Persistent Hypothyroidism and Recurrence

Abstract

Subacute thyroiditis (SAT) is an inflammatory thyroid disease. The main purpose of the treatment is to relieve pain and control the inflammatory process. The aim of the present study was to evaluate the therapeutic effects of steroid and non-steroidal anti-inflammatory drugs (NSAIDs) in SAT. Initial laboratory data, treatment response, and long-term results of 295 SAT patients treated with ibuprofen or methylprednisolone were evaluated. After the exclusion of 78 patients, evaluation was made of 126 patients treated with 1800 mg ibuprofen and 91 patients treated with 48 mg methylprednisolone. In 59.5% of 126 patients treated with ibuprofen, there was no adequate clinical response at the first control visit. In 54% of patients, the treatment was changed to steroids in mean 9.5 days. Symptomatic remission was achieved within two weeks in all patients treated with methylprednisolone. The total recurrence rate was 19.8%, and recurrences were observed more frequently in patients receiving only steroid therapy than in patients treated with NSAID only (23% vs. 10.5% p:0.04). Persistent hypothyroidism developed in 22.8% of patients treated only with ibuprofen and in 6.6% of patients treated with methylprednisolone only. Treatment with only ibuprofen (p:0.039) and positive thyroid peroxidase antibody (anti-TPO) (p:0.029) were determined as the main risk factors for permanent hypothyroidism. NSAID treatment is not as effective as steroid treatment in early clinical remission. Steroid treatment was detected as a protective factor against permanent hypothyroidism. Therefore, steroid therapy may be considered especially in anti-TPO positive SAT patients and patients with high-level acute phase reactants.

Figure 1

(A) Thyroid ultrasound typically shows a bilateral heterogeneous hypoechoic pattern, (B) hypoechoic heterogeneous area painful to the touch of the probe in the right lobe (C,D) shows no vascular flow in hypoechoic areas.

Figure 2

Patient selection protocol and clinical responses of patients. SAT: subacute thyroiditis, NSAIDs: non-steroidal anti-inflammatory drugs, APR: acute phase reactants, *2 patients had poor glycemic control, 5 patients did not accept steroid treatment, **6 patients treated with NSAID and 1 patient treated with steroid on recurrence time.

Figure 3

ROC curve analysis of ESR and CRP levels to identify a cut-off level for unresponsiveness to NSAID treatment. ESR: erythrocyte sedimentation rate; CRP: C-reactive protein NSAID: non-steroidal anti-inflammatory drug.