Management of Subacute Thyroiditis with Conventional High-Dose Prednisolone; Shooting a Tree Sparrow with a Cannonball

Abstract

Background: A well-established medical entity, and typically self-limited disorder, the subacute thyroiditis (SAT), has been conventionally treated with a large dose (40-80 mg) of prednisolone per day for decades: a nonevidence- based and utterly large dose of corticosteroid for a disease with clearly predictable self-limiting course. The current study was designed to evaluate the efficacy of prednisolone 15 mg/day instead of routinely prescribed large dose of 40-80 mg, and to investigate the rate of early relapse with low-dose protocol. Subjects and methods: In a prospective study, forty-five cases of SAT were consecutively included. The diagnosis of SAT was made based on defined criteria of persistent sore throat, rapidly developed painful goiter, suppressed TSH, high ESR, and low RAIU. They were treated with 15 mg of prednisolone per day during the first month, 10 mg per day for the second month, and finally 5 mg daily over the third month. All cases were carefully followed for a minimum of one year to track the clinical and biochemical response to therapy and to find out any evidence of early relapse after discontinuation of medication. Results: Of forty-five patients who completed the oneyear- course of follow-up, 38 were female and 7 were male (male/female ratio 5.4). Mean age of affected subjects was 39 ± 10 years, and mean ESR was 70 ± 23 mm/hr (median 75 mm/hr, range 30-117 mm/hr). Among all subjects with full-blown SAT, only one case (2.2%) remained noticeably symptomatic on 15 mg prednisolone daily after two weeks, requiring 30 mg of medicine per day for symptomatic relief and normalization of ESR. After corticosteroid withdrawal, significant relapse occurred in only two patients (4.4%). Conclusion: Our results, not only endorse the efficacy of low-dose prednisolone in management of subacute thyroiditis, but also demonstrate the remarkably less relapse with low dose corticosteroid.