A Single-Center Experience in the Diagnosis and Treatment of Subacute Thyroiditis: Should Steroids Always Be the First Choice?

Öz

We aimed to evaluate the clinical and laboratory findings of our patients with subacute thyroiditis (SAT) and their responses to the treatments given. Twenty SAT patients and 31 healthy controls were included in this retrospective case-control study. The clinical and laboratory data were obtained from the file records. The patient group consisted predominantly of women. The thyroid function tests and acute phase reactants of the patient group were different than the controls, as expected. The platelet count and alkaline phosphatase levels were found to be significantly higher in the patient group. Remission was achieved in 17 patients with non-steroidal anti-inflammatory drug (NSAID) treatment, five of the patients were administered steroid treatment in another center, and switched to NSAIDs by us. Only one patient switched from NSAIDs to steroids. Two patients were switched to acetylsalicylic acid treatment due to moderate transaminase elevation. One of the patients was in the 16th week of pregnancy and took NSAID treatment due to her appropriate trimester. Remission was achieved in all patients with the treatments we administered, and no recurrence was observed in any patient. SAT may be encountered by clinicians from different specialties in daily practice. Referral of the patient to an internist or an endocrinologist is important in terms of timely diagnosis and right treatment. Since SAT shows a self-limiting feature, clinicians should not be in a hurry to administer steroids, NSAID option should always be considered.

Anahtar Kelimeler

• Subacute thyroiditis
• non-steroidal anti-inflammatory drug treatment
• permanent hypothyroidism
• acetylsalicylic acid
• pregnancy

Subakut Tiroidit Tanı ve Tedavisinde Tek Merkez Deneyimi: Steroidler Her Zaman İlk Seçenek mi Olmalıdır?

Öz

Subakut tiroiditli (SAT) hastalarımızın klinik ve laboratuvar bulgularını ve verilen tedavilere yanıtlarını değerlendirmeyi amaçladık. Bu retrospektif vaka kontrol çalışmasına 20 SAT hastası ve 31 sağlıklı kontrol dahil edildi. Klinik ve laboratuvar veriler dosya kayıtlarından elde edildi. Hasta grubu ağırlıklı olarak kadınlardan oluşuyordu. Hasta grubunun tiroid fonksiyon testleri ve akut faz reaktanları beklendiği üzere kontrol grubundan farklıydı. Hasta grubunda trombosit sayısı ve alkalen fosfataz düzeyleri anlamlı olarak yüksek bulundu. Non-steroid antiinflamatuar ilaç (NSAİİ) tedavisi ile 17 hastada remisyon sağlandı, hastaların beşine başka bir merkezde steroid tedavisi başlanmıştı ve tarafımızca NSAİİ'lere geçildi. Sadece bir hasta NSAİİ tedaviden steroide geçti. İki hastada orta derecede transaminaz yüksekliği nedeniyle asetilsalisilik asit tedavisine geçildi. Hastalardan biri gebeliğinin 16. haftasındaydı ve uygun trimester nedeniyle NSAİİ tedavisi aldı. Uyguladığımız tedaviler ile tüm hastalarda remisyon sağlandı ve hiçbir hastada nüks görülmedi. SAT, günlük pratikte farklı uzmanlıklardan klinisyenlerin karşısına çıkabilir.Hastanın iç hastalıkları veya endokrinoloji uzmanına sevki zamanında tanı ve doğru tedavi açısından önemlidir. SAT kendi kendini sınırlayıcı bir özellik gösterdiğinden klinisyenlerin steroid tedavisi konusunda aceleci olmaması gerekir, NSAİİ tedavi seçeneği her zaman düşünülmelidir.

Anahtar Kelimeler

• Subakut tiroidit
• non-steroid antiinflamatuar ilaç tedavisi
• kalıcı hipotiroidi
• asetilsalisilik asit
• gebelik

Kaynakça

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