Prednisone Dosing for Subacute Thyroiditis
For patients with subacute thyroiditis, the recommended initial dose of prednisone is 15-30 mg daily for 1-2 weeks, followed by gradual tapering over 4-6 weeks. 1, 2
Initial Dosing Recommendations
- For mild to moderate cases: Start with 15-20 mg daily of prednisone 1, 3
- For severe cases or those with poor response to NSAIDs: Start with 30-40 mg daily 2, 4
- Short-term prednisone (30 mg/day for 1 week) followed by NSAIDs has shown similar efficacy with fewer side effects compared to conventional 6-week therapy 2
Tapering Schedule
- After 1-2 weeks of initial therapy with symptom improvement, begin tapering the dose 3, 2
- A common approach is to reduce the dose by 5 mg every 5-7 days 3
- Complete tapering over 4-6 weeks total treatment duration 2, 1
- Monitor for symptom recurrence during tapering; if symptoms return, increase to the previous effective dose 4
Evidence-Based Considerations
- A randomized controlled trial demonstrated that 15 mg/day initial dose was non-inferior to 30 mg/day in terms of efficacy and showed a similar safety profile 1
- Lower initial doses (15 mg/day) resulted in significantly lower total steroid exposure (330 mg vs 595 mg) with equivalent clinical outcomes 1
- Short-term prednisone treatment (30 mg/day for 1 week) followed by NSAIDs showed similar efficacy and recurrence rates compared to conventional 6-week treatment 2
Special Situations
- For steroid-resistant cases (rare): Consider increasing the dose up to 50-75 mg daily, though evidence suggests that doses above conventional maximums may not provide additional benefit 5
- In cases of complete steroid resistance despite prolonged high-dose treatment (e.g., 50-75 mg daily for 1-9 months), thyroidectomy may be necessary 5
- For elderly patients or those with comorbidities, consider starting at the lower end of the dosing range (15-20 mg daily) to minimize adverse effects 6
Monitoring and Follow-up
- Assess response to treatment within 24-48 hours; most patients experience rapid symptom relief with appropriate steroid dosing 4
- Monitor ESR and CRP as markers of inflammation; ESR typically normalizes within 4 weeks of treatment 3
- Watch for recurrences, which occur in a small percentage of patients and may require restoration of a higher dose 4
- Monitor thyroid function during and after treatment, as transient hypothyroidism may develop 2, 1