How is subacute granulomatous thyroiditis treated?

Updated: Mar 23, 2021
  • Author: Stephanie L Lee, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Management of subacute granulomatous thyroiditis is directed towards 2 problems: pain and thyroid dysfunction.

Thyroid pain in this condition can be extreme (although some patients with mild pain require no treatment). Nonsteroidal anti-inflammatory drugs (NSAIDs)—such as such as ibuprofen (800-1200 mg/day in divided doses) and naproxen (1-1.5 g/day in divided doses)—are the first-line agents used for pain treatment, although large dosages are typically needed. Treatment can be tapered as allowed by the patient's pain.

Most NSAIDs provide comparable efficacy in pain relief. Avoid high-dose aspirin because, in some circumstances, aspirin can competitively displace thyroid hormone from its binding protein and increase the free, or bioactive, fraction of thyroid hormone, which can make patients feel more thyrotoxic. Analgesic therapy can usually be stopped after 2-6 weeks.

In extreme cases, stronger pain medications, including narcotic analgesics, are indicated for a brief period of 2-3 weeks. In the most extreme cases, high-dose steroids (eg, prednisone 40-60 mg/day) must be administered. Corticosteroids are highly effective, and relief of pain is quick and dramatic. If pain and tenderness do not disappear within 72 hours after the start of therapy, the diagnosis of subacute thyroiditis should be questioned. Symptoms of thyrotoxicosis are also alleviated with glucocorticoids.

Research indicates that prednisolone 15 mg/day with a taper of 5 mg every 2 weeks is a safe and effective means of quickly reducing pain. In a study of prednisolone use by Kubota et al, most patients had resolution of symptoms by 6-8 weeks, although the longest period of therapy was 40 weeks. [21]  A study by Sato et al found that prednisolone (mean dose 15 mg/day) more quickly resolved symptoms of subacute thyroiditis than did the nonsteroidal anti-inflammatory drug loxoprofen (mean dose 180 mg/day) (7 vs 21 days to resolution, respectively). However, in the report, of 42 patients treated with either medication, the two drugs were comparable with regard to time to normalization of thyroid function. [46]


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