Journal of the Endocrine Society · 2026
Preventive effect of prednisolone on permanent hypothyroidism in subacute thyroiditis: retrospective study of 743 cases.
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Suzuki Ai, Watanabe Natsuko, Noh Jaeduk Yoshimura, Imai Hideyuki, Hiruma Shigenori, Kinoshita Aya, Aida Azusa, Suzuki Nami, Fukushita Miho, Matsumoto Masako, Yoshihara Ai, Sugino Kiminori, Ito Koichi
Аннотация
PURPOSE: Permanent hypothyroidism (PH) after subacute thyroiditis (SAT) requires lifelong thyroid hormone replacement therapy. This study aimed to investigate the risk factors for PH and its association with treatment.
METHODS: A retrospective observational study of 743 patients diagnosed with SAT from 2016 to 2019 was conducted.
RESULTS: Initial treatment was prednisolone (PSL) in 332 patients (44.7%), nonsteroidal anti-inflammatory drugs (NSAIDs) in 364 (49.0%), and rest without medication in 47 (6.3%). Of the NSAID-treated patients, 238 (65.4%) switched to PSL. Final treatment was PSL in 570 (76.7%), NSAIDs in 126 (17.0%), and rest in 47 (6.3%). Permanent hypothyroidism occurred in 32 patients (4.3%). Prednisolone therapy was used less frequently in the PH group (46.9%) than in the euthyroid group (78.1%, P < .01). Multivariable logistic regression identified no PSL therapy (odds ratio [OR] 3.92, 95% confidence interval [CI] 1.88-8.24, P < .01) and male sex (OR 2.52, 95% CI 1.13-5.37, P = .03) as significant risk factors for PH.Compared with patients aged <70 years, those ≥70 years had significantly lower free triiodothyronine, free thyroxine, and C-reactive protein levels, but higher thyroid-stimulating hormone levels. The proportion of elderly patients receiving PSL therapy was lower (56.1% vs 77.9%; P < .01), and the duration of PSL therapy was shorter (P = .01).
CONCLUSION: Prednisolone therapy for SAT helps prevent PH through its anti-inflammatory effects. In younger patients, early PSL therapy may be preferable to reduce the risk of PH, as PH requires long-term levothyroxine therapy. In elderly patients, NSAIDs were often sufficient, whereas PSL therapy may be considered when clinically indicated.
METHODS: A retrospective observational study of 743 patients diagnosed with SAT from 2016 to 2019 was conducted.
RESULTS: Initial treatment was prednisolone (PSL) in 332 patients (44.7%), nonsteroidal anti-inflammatory drugs (NSAIDs) in 364 (49.0%), and rest without medication in 47 (6.3%). Of the NSAID-treated patients, 238 (65.4%) switched to PSL. Final treatment was PSL in 570 (76.7%), NSAIDs in 126 (17.0%), and rest in 47 (6.3%). Permanent hypothyroidism occurred in 32 patients (4.3%). Prednisolone therapy was used less frequently in the PH group (46.9%) than in the euthyroid group (78.1%, P < .01). Multivariable logistic regression identified no PSL therapy (odds ratio [OR] 3.92, 95% confidence interval [CI] 1.88-8.24, P < .01) and male sex (OR 2.52, 95% CI 1.13-5.37, P = .03) as significant risk factors for PH.Compared with patients aged <70 years, those ≥70 years had significantly lower free triiodothyronine, free thyroxine, and C-reactive protein levels, but higher thyroid-stimulating hormone levels. The proportion of elderly patients receiving PSL therapy was lower (56.1% vs 77.9%; P < .01), and the duration of PSL therapy was shorter (P = .01).
CONCLUSION: Prednisolone therapy for SAT helps prevent PH through its anti-inflammatory effects. In younger patients, early PSL therapy may be preferable to reduce the risk of PH, as PH requires long-term levothyroxine therapy. In elderly patients, NSAIDs were often sufficient, whereas PSL therapy may be considered when clinically indicated.