Evaluation of Recurrence in 36 Subacute Thyroiditis Patients Managed with Prednisolone.

Abstract

Objective The incidence of subacute thyroiditis (SAT) is lowand there are a fewreports of recurrence of subacute thyroiditis. Current treatment protocols for SATare not uniform. Prednisolone (PSL) is chosen more often for treatment than nonsteroidal anti-inflammatory drugs. This study was undertaken to confirm the recurrence rate of SAT managed by PSL, and to compare the initial laboratory data between the recurrent and the non-recurrent groups. Methods After diagnosis, all patients were treated with PSL (starting at 30 mg or 25 mg per day, tapered by 5 mg per week) for 5 or 6 weeks. Weevaluated data and symptoms at the first visit and during the therapy. Patients Thirty-six patients who received only PSL for SATat our hospital between January 1997 and December 1998 were referred. These patients asked to visit every 2 weeks for the monitoring of symptoms and laboratory data. Results SAT symptoms recurred in eight patients (22%), most upon cessation of PSL. There was no difference in initial serum sialic acid, erythrocyte sedimentation rate, Creactive protein, thyroglobulin, serum free thyroxine and free triiodothyronine before PSLtreatment between the recurrent and non-recurrent patient populations.Conclusions The recurrence rate of SATwith treated PSL is about 20%. There was no difference in the laboratory data before starting the therapy between recurrent and non-recurrent groups. Therefore, a modified protocol of PSL administration may be needed to decrease the early recurrent rate of SAT. (Internal Medicine 40: 292-295, 2001)

Prednisolone Dosing Regimen for Treatment of Subacute Thyroiditis

“…The recurrence rate of 15.2% noted in the present study was similar to that reported in previous studies (ranging from 10 to 20%) [3,9]. Mizukoshi et al [9] noted that the breaking point for recurrence may occur at a 10 mg PSL dose, and suggested that extending the period under treatment with 10 mg PSL may help reduce the recurrence rate [9]. In our study, recurrence was also observed when the PSL dose was tapered from 10 to 5 mg/day, which was in agreement with the above results reported by Mizukoshi et al [9].…”

“…These results point to similarities of the phenotype in the two studies, though with slightly lower rates of these two features of SAT in our group of patients. The recurrence rate of 15.2% noted in the present study was similar to that reported in previous studies (ranging from 10 to 20%) [3,9]. Mizukoshi et al [9] noted that the breaking point for recurrence may occur at a 10 mg PSL dose, and suggested that extending the period under treatment with 10 mg PSL may help reduce the recurrence rate [9].…”

“…In another study of 36 patients with SAT [9] in which the initial dose of 25 or 30 mg/day of PSL was tapered to 5 mg/day weekly over a period of 5 to 6 weeks, the relapse rate was 22%, with no differences in pretreatment levels of ESR, leukocyte count, C-reactive protein (CPR), Tg, FT3 and FT4 between the non-recurrence and recurrence groups [9]. Our results confirm the findings of the above study [9] and point to the importance of tapering PSL over a relatively long period of time.…”

“…Mizukoshi et al [9] noted that the breaking point for recurrence may occur at a 10 mg PSL dose, and suggested that extending the period under treatment with 10 mg PSL may help reduce the recurrence rate [9]. In our study, recurrence was also observed when the PSL dose was tapered from 10 to 5 mg/day, which was in agreement with the above results reported by Mizukoshi et al [9]. The initial PSL dose varied from 15 to 30 mg/day, but there was no significant difference in the initial PSL dose between the non-recurrence (24.5 ± 5.3 mg/day) and recurrence groups (27.5 ± 5.0 mg/day).…”

“…Recurrence of SAT after completion of treatment is rare (approximately 2%) [4][5][6]. While studies have re-ported that the recurrence rate during treatment with prednisolone (PSL) is approximately 2.2% [7] or 35% [8], it is generally thought that the SAT relapse rate is approximately 10 to 20% [3,9]. Clinically, a rapid tapering of PSL during treatment can increase the likelihood of a recurrence, and thus tapering schedules of 1 to 2 weeks are recommended [10].…”