Treatment of Acute Painful Thyroiditis with Low Dose Prednisolone: A Study on Patients from Western Nepal

Introduction: Thyroiditis is a disorder that involves inflammation of the thyroid gland. Subacute thyroiditis is the most common cause of acute painful thyroiditis. It is thought to be a viral inflammatory disorder. Subacute thyroiditis has been treated with either nonsteroidal anti-inflammatory drugs (NSAIDs) or high dose corticosteroids. The response to steroids is more dramatic and quicker than the NSAIDs. Prednisolone is the most commonly used corticosteroid to treat subacute thyroiditis. The usual dose is one mg/kg/day tapered over six weeks although the basis for this dose has not been established yet by prospective studies. Aim: The current research was carried out to study if prednisolone in lower initial dose (20 mg/day tapered over four weeks) is effective in patients with acute painful thyroiditis. Materials and Methods: This study was a prospective, cross sectional, observational study carried out at Pokhara, Nepal. All the patients presenting with anterior neck pain of less than 1 week with tender thyroid on palpation and ESR more than 30mm/h were included in the study. The patients were administered prednisolone in a starting dose of 20 mg/day tapered over four weeks. Data were collected, analysed and the results were interpreted. Results: One hundred and twenty two patients of acute painful thyroiditis were included in our study. Age of the patients ranged from 19 years to 69 years with the mean age of 36.58 years. Female to Male ratio was 10:1. Mean ESR was 57.03 at the time of presentation. ESR decreased to 29.63 at two weeks and 17.03 mm per hour (normal) at 4 weeks after continuation of the drug. All the patients reported with severe pain in the anterior neck at the time of presentation. Pain was completely relieved in 115 patients (94%) at 2 weeks after starting the treatment and it was better than previous in seven patients. Conclusion: Twenty mg of prednisolone daily tapered over 4 weeks is an adequate treatment of subacute thyroiditis. However, dose can be drastically tapered after 2 weeks.