Prednisolone Dosing Regimen for Treatment of Subacute Thyroiditis

Abstract

: The rate of recurrence of subacute thyroiditis (SAT) during prednisolone (PSL) therapy is approximately 10 to 20%. However, there is little or no information on the time period to relapse following administration of a tapered dose of PSL and the factors associated with such relapse. The aim of this study was to determine the correlation between SAT recurrence and PSL tapering regimen used in the treatment of SAT. This study was a medical record-based retrospective study and involved 26 patients (3 men, 23 women) who received PSL therapy for SAT. The primary endpoint was the association between recurrence and number of days required to taper daily PSL dose to 5 mg. The secondary endpoint was the relationship between recurrence and several variables including age, clinical score, free thyroxine, inf lammatory reaction, thyroglobulin, total treatment time, total dose of PSL and presence or absence of creeping thyroiditis. The SAT recurrence rate was 15.3%. There was no significant difference in the initial PSL dose between the non-recurrence and recurrence groups (27.5 mg vs 24.5 mg, P = 0.302). However, for the primary endpoint, significant differences were found between the two groups in time required for tapering PSL to 5 mg/day (non-recurrence: 44.3 ± 15.3 days, recurrence: 19.0 ± 11.9 days, P = 0.012). None of the clinical variables evaluated correlated significantly with SAT relapse. In conclusion, to prevent recurrence of SAT, consideration should be given to the period required for PSL tapering to 5 mg/day.

The Risk of Recurrence of Subacute Thyroiditis Is HLA-Dependent

“…The recurrence of symptoms often occurs when the dose of prednisone is tapered to 5–10 mg. The recurrence rate during treatment with prednisolone was reported to range from 2.2% to 35% [11]. In such patients, the tapering regimen should be very slow, and prolonged steroid treatment is required [12].…”

“…The reason for SAT relapse is still unknown. Some authors postulate that a too short period of steroid therapy is the causative factor [11]. Shortening of the time of steroid therapy may result in the recurrence of SAT symptoms due to treatment withdrawal before the complete SAT resolution.…”

“…Shortening of the time of steroid therapy may result in the recurrence of SAT symptoms due to treatment withdrawal before the complete SAT resolution. However, a short-time steroid regimen may be associated with a higher risk of SAT recurrence, even in patients with complete remission after therapy of the first episode of the disease [11]. Additionally, the SAT recurrence occurs also in several percent of patients treated with steroids according to the prolonged regimen (i.e., starting from 40 mg of prednisone and tapering the dose for 5 mg every week) [2,11].…”

“…However, a short-time steroid regimen may be associated with a higher risk of SAT recurrence, even in patients with complete remission after therapy of the first episode of the disease [11]. Additionally, the SAT recurrence occurs also in several percent of patients treated with steroids according to the prolonged regimen (i.e., starting from 40 mg of prednisone and tapering the dose for 5 mg every week) [2,11]. In some patients, even steroid dependence occurs, and any attempt to discontinue treatment results in SAT relapse.…”

Diagnostic and Therapeutic Challenges of De Quervain Thyroiditis in Sub-Saharan Africa: Illustration with Two New Cases in Dakar

“…It persisted nevertheless biological sub-clinical hyperthyroidism after only four weeks of treatment as well ultrasound abnormalities which are normalized usually more slowly than clinical signs [2]. A short time of treatment's maintenance (less than 3 weeks) with 5 mg of prednisone would in addition be correlated with the risk of relapse [13].…”