International Journal of General Medicine (Aug 2022)
Management of Subacute Thyroiditis – A Systematic Review of Current Treatment Protocols
Abstract
Ishita Ray,1 Brandon D’Souza,2 Pallab Sarker,3 Pawan Agarwal4 1Department of Medicine, Mahatma Gandhi Memorial Medical College, Indore, India; 2Department of Medicine, Dr. D.Y. Patil Medical College, Pimpri-Chinchwad, India; 3Department of Medicine, Sher E Bangla Medical College, Barisal City, Bangladesh; 4Department of Surgery, Netaji Subhash Chandra Bose Medical College Jabalpur, Jabalpur, IndiaCorrespondence: Ishita Ray, Madan Mahal Hospital, Prem Nagar, Nagpur Road, Jabalpur, Madhya Pradesh, 482001, India, Tel +918959393344, Email [email protected]: This systematic review endeavors to find an effective treatment protocol for subacute thyroiditis (SAT) to minimize side effects, recurrence and long-term hypothyroidism.Materials and Methods: We analyzed available original studies on treatment protocols for SAT. A thorough literature search was performed on the following online databases PubMed, Cochrane library nd Google Scholar using appropriate keywords for choosing relevant articles. Two reviewers assessed the methodological quality of selected articles independently using a critical appraisal instrument. The results were analyzed and synthesized qualitatively using the level of evidence method.Results: The literature search retrieved a total of 460 publications after abstract screening; out of which 36 articles met the inclusion criteria. After full text screening, 23 articles were further excluded as they were focusing on aspects of SAT other than management, the remaining 15 articles were investigated for both reliability and validity. Thirteen studies provided low-quality evidence, and two randomized control trials (RCT) provided a high quality of evidence. Steroid therapy was found to be the most effective for moderate to severe SAT and provided relief from acute symptoms but was found to not be a risk factor for recurrence. Low initial doses of steroid (15 mg) were preferred over high initial dosage (30– 40 mg). Furthermore, a look into the mode of steroid delivery (RCT) revealed that intrathyroidal steroid therapy can potentially become a safer and faster mode of therapy. The duration of tapering was found to be of significance as a short tapering period was linked with greater recurrence rates.Conclusion: Low initial doses of steroid along with an extended tapering period may help lower recurrence rates; also, intrathyroidal steroid injections are potentially a better alternative to oral prednisone (PSN) with regard to safety and speed of action. However, the evidence is of moderate quality and further investigation is required.Keywords: subacute thyroiditis, de Quervain thyroiditis, painful thyroiditis, steroid, NSAIDS, recurrence
