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Short-term versus 6-week prednisone in the treatment of subacute thyroiditis: a randomized controlled trial

By Lian Duan, Xiaoli Feng, Rui Zhang, Xiaojuan Tan, Xiaoyan Xiang, Rufei Shen, Hongting Zheng

Posted 20 Feb 2020
medRxiv DOI: 10.1101/2020.02.15.20023283

BackgroundModerate-to-severe subacute thyroiditis is commonly treated with 6-8 weeks glucocorticoids; however, no studies have described short-term prednisone treatment for subacute thyroiditis. We evaluated the efficacy of this treatment for subacute thyroiditis. MethodsThis was a 24-week, prospective, single-blind, randomized controlled study. Patients aged 18-70 years with subacute thyroiditis were hospitalized from August 2013 to December 2014. Patients with moderate-to-severe symptoms were randomized to receive either 30 mg/d prednisone for 1 week and then switched to 1 week of nonsteroidal anti-inflammatory drugs or 6 weeks of prednisone. The primary endpoints were the differences in efficacy at the end of treatment between two groups. Secondary endpoints included differences between the two groups in parameters of side effects at withdrawal and thyroid function at weeks 6, 12, 24. ResultsOf 96 patients screened, 52 subjects were randomized and 50 completed the study. Efficacy and recurrence rates were not significantly different at withdrawal in both groups (P=0.65). Parathyroid hormone (28.8 vs 38.9 pg/ml, p=0.011) and mean systolic blood pressure (113.9 vs 122.4 mmHg, p=0.023) were significantly lower in the experimental group than in the control group at discontinuation. No significant differences were observed in other secondary endpoints at withdrawal and in thyroid function at the 6th, 12th and 24th week during the follow-up time between the two groups. ConclusionsFewer side effects of glucocorticoids and similar efficacy and recurrence rates were observed with short-term prednisone compared with those with 6-week treatment for subacute thyroiditis. Short-term prednisone with a better safety profile may be as one alternative strategy for ameliorating moderate-to-severe symptoms of subacute thyroiditis. Trial registrationTrial registration number NCT01837433. Registered with Clinicaltrials.gov on 23 April 2013

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