From the Research
The conventional 6-week protocol for treating subacute thyroiditis with prednisone typically begins with 40 mg daily for the first week, followed by a gradual taper over the remaining five weeks. The dosage is usually reduced to 30 mg daily in the second week, 20 mg daily in the third week, 15 mg daily in the fourth week, 10 mg daily in the fifth week, and 5 mg daily in the sixth week before discontinuation. This tapering approach helps manage the painful inflammatory symptoms of subacute thyroiditis while minimizing the risk of symptom rebound that can occur with abrupt discontinuation. Prednisone should be taken with food to reduce gastrointestinal irritation, and patients should be monitored for potential side effects including elevated blood glucose, mood changes, and increased susceptibility to infections. The corticosteroid works by suppressing the inflammatory process in the thyroid gland, which helps alleviate pain and tenderness. This treatment is particularly effective for patients with moderate to severe pain who have not responded adequately to NSAIDs or who cannot tolerate them. If symptoms recur during or after tapering, the dose may need to be temporarily increased before attempting another gradual taper, as suggested by studies such as 1 and 2. However, it's worth noting that a study from 1 found that short-term prednisone treatment may be an alternative strategy for ameliorating moderate-to-severe symptoms of subacute thyroiditis, with fewer side effects of glucocorticoids and similar efficacy and recurrence rates compared to the 6-week treatment. In clinical practice, the choice of treatment protocol may depend on individual patient factors and the severity of symptoms, with the goal of minimizing morbidity, mortality, and improving quality of life. Some studies, such as 3, have also explored the use of lower initial doses of prednisolone, such as 20 mg/day tapered over four weeks, which may be an adequate treatment for subacute thyroiditis. Overall, the treatment of subacute thyroiditis with prednisone should be tailored to the individual patient's needs and response to therapy, with careful monitoring for potential side effects and adjustment of the treatment protocol as needed, as supported by studies such as 4 and 5.