Comparison of efficacy, adverse effects and clinical outcomes of non-steroidal anti-inflammatory drugs and steroids in patients diagnosed with subacute thyroiditis

Subacute thyroiditis is an inflammatory and generally self-limiting thyroid disease which is thought to be a consequence of a viral infection or viral infection related inflammatory response in patients with genetic predisposition. There is generally pain or feeling of discomfort in the neck which is often accompanied by thyrotoxicosis. The most important goal of the therapy is therefore relieving the pain and tenderness as well as resolving the symptoms of thyrotoxicosis if any. Also, patients should be monitored in terms of relapse and recurrence as well as development of hypothyroidism. Most of the patients need to be treated by either non-steroidal anti-inflammatory drugs (NSAIDs) or steroids. However, there is insufficient data regarding the choice and the dose of the therapy. In this study, we have included 63 patients who were diagnosed with subacute thyroiditis in Endocrinology and Metabolism Clinic in Dokuz Eylul University Faculty of Medicine and aimed to define their clinical, biochemical and ultrasonographic characteristics of at the time of diagnosis and during follow-up. We have also investigated the efficacies of NSAİD and different doses of steroid treatments which were prescribed by physicians following the patients. We also aimed to investigate the effects of treatment choice on rates of relapse, recurrence and development of hypothyroidism as well as on life and sleep qualities of the patients. Three groups of patients were evaluated including patients receiving NSAİD and receiving steroids with initial doses of 0.5 mg/kg/day and 15 mg/day. In addition to biochemical and ultrasonographic evaluation, patients were also evaluated regarding their pain, life quality and sleep quality. In conclusion; according to results of our study, it is appropriate to start NSAİD treatment to patients with subacute thyroiditis and to switch to steroid treatment according to clinical and laboratory response during follow-up. We have also shown that for patients with no response to NSAİD therapy, an initial low dose of steroid (15 mg/day) is determined as a safe treatment method when dose reduction is performed with appropriate timing. None of the patients receiving low-dose steroid therapy had relapse or early recurrence. The threshold white blood cell value for predicting NSAİD unresponsiveness was determined as 8.3 (103/uL). The long symptom duration until diagnosis and treatment with NSAİD were found to be associated with development of hypothyroidism at the sixth month. In our study, the rate of thyroid malignancy was determined as 3.17%. This study, which examined the effect of subacute thyroiditis on life and sleep qualities for the first time, showed that subacute thyroiditis significantly impaired these parameters and all treatment modalities showed a significant improvement on these parameters.