From the Guidelines
The treatment for subacute thyroiditis primarily focuses on symptom management, with beta-blockers such as propranolol (10-40 mg three to four times daily) recommended for hyperthyroid symptoms, and nonsteroidal anti-inflammatory drugs (NSAIDs) or prednisone for pain relief and inflammatory management, as outlined in the most recent guidelines 1.
Treatment Approach
The approach to treating subacute thyroiditis depends on the severity of symptoms, which can be categorized into different grades.
- For mild cases (Grade 1), beta-blockers such as atenolol or propranolol can be used for symptomatic relief, with close monitoring of thyroid function every 2-3 weeks after diagnosis 1.
- For moderate cases (Grade 2), consideration should be given to holding immune checkpoint inhibitors (ICPi) until symptoms return to baseline, with beta-blockers and hydration and supportive care as needed, and endocrine consultation for additional workup if thyrotoxicosis persists beyond 6 weeks 1.
- For severe cases (Grade 3-4), ICPi should be held until symptoms resolve to baseline with appropriate therapy, with endocrine consultation, beta-blockers, hydration, and supportive care, and consideration of hospitalization for severe cases, where additional medical therapies including steroids, SSKI, or thionamide may be necessary 1.
Monitoring and Follow-Up
Patients should be monitored closely with regular symptom evaluation and thyroid function tests, including TSH and free T4 testing, every 2-4 weeks initially, then every 1-2 months until recovery, to catch the transition to hypothyroidism and manage it appropriately with levothyroxine replacement if necessary 1.
Additional Considerations
It's also important to note that subacute thyroiditis can have different phases, including a hyperthyroid phase where beta-blockers may be beneficial, and a hypothyroid phase where thyroid hormone replacement may be necessary, as highlighted in guidelines from the Society for Immunotherapy of Cancer (SITC) toxicity management working group 1.
From the FDA Drug Label
nonsuppurative thyroiditis The treatment for subacute thyroiditis may include prednisone (PO), as it is listed under the conditions for which the drug is indicated, specifically nonsuppurative thyroiditis 2.
- The use of prednisone is likely aimed at reducing inflammation and managing symptoms associated with subacute thyroiditis.
- Short-term administration of prednisone may be used to tide the patient over an acute episode or exacerbation of the condition.
From the Research
Treatment Options for Subacute Thyroiditis
The treatment for subacute thyroiditis focuses on relieving pain and controlling the inflammatory process. The following options are available:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 3
- Corticosteroids such as prednisolone 3, 4, 5
- Colchicine may be therapeutic in patients with prednisolone-refractory, recurrent subacute thyroiditis 6
Effectiveness of Treatment Options
- NSAID treatment is not as effective as steroid treatment in early clinical remission 3
- Steroid treatment was detected as a protective factor against permanent hypothyroidism 3
- Low-dose prednisolone (20 mg/day tapered over four weeks) is an adequate treatment for subacute thyroiditis 4
- Short-term prednisone treatment may be an alternative strategy for ameliorating moderate-to-severe symptoms of subacute thyroiditis 5
Management of Symptoms
- Beta blockers can treat adrenergic symptoms in the hyperthyroid phase 7
- In the hypothyroid phase, treatment is generally not necessary but may be used in patients with signs and symptoms of hypothyroidism or permanent hypothyroidism 7
- Nonsteroidal anti-inflammatory drugs and corticosteroids are indicated for the treatment of thyroid pain 7