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

Yıl 2022, Cilt: 44 Sayı: 5, 715 - 721, 29.09.2022
https://doi.org/10.20515/otd.1135858

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.

Kaynakça

  • 1. Fatourechi V, Aniszewski JP, Fatourechi GZ, et al. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab. 2003 May;88(5):2100-5.
  • 2. Golden SH, Robinson KA, Saldanha I, et al. Clinical review: Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab. 2009 Jun;94(6):1853-78.
  • 3. Burman KD. Subacute thyroiditis. In: Post TW, editor. UpToDate. Waltham (MA): UpToDate. [accessed 2022 June 24].
  • 4. Ohsako N, Tamai H, Sudo T, et al. Clinical characteristics of subacute thyroiditis classified according to human leukocyte antigen typing. J Clin Endocrinol Metab. 1995 Dec;80(12):3653-6.
  • 5. Guimataes VC. Subacute and Riedel’s thyroiditis. In: Jameson JL, De Groot LJ , editors. Endocrinology adult and pediatric 7th ed. Philadelphia:Elsevier Saunders;2016. p. 1528-35.
  • 6. Nishihara E, Ohye H, Amino N, et al. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Intern Med. 2008;47(8):725-9.
  • 7. Stasiak M, Michalak R, Stasiak B, et al. Clinical characteristics of subacute thyroiditis is different than it used to be - current state based on 15 years own material. Neuro Endocrinol Lett. 2019 Feb;39(7):489-95.
  • 8. Ricci D, Brancatella A, Marinò M, et al. The detection of serum IgMs to thyroglobulin in subacute thyroiditis suggests a protective role of IgMs in thyroid autoimmunity. J Clin Endocrinol Metab. 2020 Jun 1;105(6):dgaa038.
  • 9. Santhosh-Kumar CR, Yohannan MD, Higgy KE, et al. Thrombocytosis in adults: analysis of 777 patients. J Intern Med. 1991 Jun;229(6):493-5.
  • 10. Yanagisawa T, Sato K, Kato Y, et al. Rapid differential diagnosis of Graves' disease and painless thyroiditis using total T3/T4 ratio, TSH, and total alkaline phosphatase activity. Endocr J. 2005 Feb;52(1):29-36.
  • 11. Banovac K, Koren E. Triiodothyronine stimulates the release of membrane-bound alkaline phosphatase in osteoblastic cells. Calcif Tissue Int. 2000 Dec;67(6):460-5.
  • 12. Galușca D, Popoviciu MS, Babeș EE, et al. Vitamin D implications and effect of supplementation in endocrine disorders: autoimmune thyroid disorders (Hashimoto's disease and Grave's disease), diabetes mellitus and obesity. Medicina (Kaunas). 2022 Jan 27;58(2):194.
  • 13. Calapkulu M, Sencar ME, Sakiz D, et al. The importance of vitamin D level in subacute thyroiditis disease and the effect of vitamin D on disease prognosis. Endocr Pract. 2020 Oct;26(10):1062-9.
  • 14. Greene JN. Subacute thyroiditis. Am J Med. 1971 Jul;51(1):97-108.
  • 15. Steinberg FU. Subacute granulomatous thyroiditis: a review. Ann Intern Med. 1960 May;52:1014-25.
  • 16. Kubota S, Nishihara E, Kudo T, et al. Initial treatment with 15 mg of prednisolone daily is sufficient for most patients with subacute thyroiditis in Japan. Thyroid. 2013 Mar;23(3):269-72.
  • 17. Mizukoshi T, Noguchi S, Murakami T, et al. Evaluation of recurrence in 36 subacute thyroiditis patients managed with prednisolone. Intern Med. 2001 Apr;40(4):292-5.
  • 18. Sencar ME, Calapkulu M, Sakiz D, et al. An evaluation of the results of the steroid and non-steroidal anti-inflammatory drug treatments in subacute thyroiditis in relation to persistent hypothyroidism and recurrence. Sci Rep. 2019 Nov 15;9(1):16899.
  • 19. Bogazzi F, Dell'Unto E, Tanda ML, et al. Long-term outcome of thyroid function after amiodarone-induced thyrotoxicosis, as compared to subacute thyroiditis. J Endocrinol Invest. 2006 Sep;29(8):694-9.
  • 20. Bai CF, Shen GH, Yang Y, et al. Correction to: Subacute thyroiditis during early pregnancy: a case report and literature review. BMC Pregnancy Childbirth. 2022 Jan 31;22(1):86. Erratum for: BMC Pregnancy Childbirth. 2022 Jan 7;22(1):19.

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

Yıl 2022, Cilt: 44 Sayı: 5, 715 - 721, 29.09.2022
https://doi.org/10.20515/otd.1135858

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.

Kaynakça

  • 1. Fatourechi V, Aniszewski JP, Fatourechi GZ, et al. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab. 2003 May;88(5):2100-5.
  • 2. Golden SH, Robinson KA, Saldanha I, et al. Clinical review: Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab. 2009 Jun;94(6):1853-78.
  • 3. Burman KD. Subacute thyroiditis. In: Post TW, editor. UpToDate. Waltham (MA): UpToDate. [accessed 2022 June 24].
  • 4. Ohsako N, Tamai H, Sudo T, et al. Clinical characteristics of subacute thyroiditis classified according to human leukocyte antigen typing. J Clin Endocrinol Metab. 1995 Dec;80(12):3653-6.
  • 5. Guimataes VC. Subacute and Riedel’s thyroiditis. In: Jameson JL, De Groot LJ , editors. Endocrinology adult and pediatric 7th ed. Philadelphia:Elsevier Saunders;2016. p. 1528-35.
  • 6. Nishihara E, Ohye H, Amino N, et al. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Intern Med. 2008;47(8):725-9.
  • 7. Stasiak M, Michalak R, Stasiak B, et al. Clinical characteristics of subacute thyroiditis is different than it used to be - current state based on 15 years own material. Neuro Endocrinol Lett. 2019 Feb;39(7):489-95.
  • 8. Ricci D, Brancatella A, Marinò M, et al. The detection of serum IgMs to thyroglobulin in subacute thyroiditis suggests a protective role of IgMs in thyroid autoimmunity. J Clin Endocrinol Metab. 2020 Jun 1;105(6):dgaa038.
  • 9. Santhosh-Kumar CR, Yohannan MD, Higgy KE, et al. Thrombocytosis in adults: analysis of 777 patients. J Intern Med. 1991 Jun;229(6):493-5.
  • 10. Yanagisawa T, Sato K, Kato Y, et al. Rapid differential diagnosis of Graves' disease and painless thyroiditis using total T3/T4 ratio, TSH, and total alkaline phosphatase activity. Endocr J. 2005 Feb;52(1):29-36.
  • 11. Banovac K, Koren E. Triiodothyronine stimulates the release of membrane-bound alkaline phosphatase in osteoblastic cells. Calcif Tissue Int. 2000 Dec;67(6):460-5.
  • 12. Galușca D, Popoviciu MS, Babeș EE, et al. Vitamin D implications and effect of supplementation in endocrine disorders: autoimmune thyroid disorders (Hashimoto's disease and Grave's disease), diabetes mellitus and obesity. Medicina (Kaunas). 2022 Jan 27;58(2):194.
  • 13. Calapkulu M, Sencar ME, Sakiz D, et al. The importance of vitamin D level in subacute thyroiditis disease and the effect of vitamin D on disease prognosis. Endocr Pract. 2020 Oct;26(10):1062-9.
  • 14. Greene JN. Subacute thyroiditis. Am J Med. 1971 Jul;51(1):97-108.
  • 15. Steinberg FU. Subacute granulomatous thyroiditis: a review. Ann Intern Med. 1960 May;52:1014-25.
  • 16. Kubota S, Nishihara E, Kudo T, et al. Initial treatment with 15 mg of prednisolone daily is sufficient for most patients with subacute thyroiditis in Japan. Thyroid. 2013 Mar;23(3):269-72.
  • 17. Mizukoshi T, Noguchi S, Murakami T, et al. Evaluation of recurrence in 36 subacute thyroiditis patients managed with prednisolone. Intern Med. 2001 Apr;40(4):292-5.
  • 18. Sencar ME, Calapkulu M, Sakiz D, et al. An evaluation of the results of the steroid and non-steroidal anti-inflammatory drug treatments in subacute thyroiditis in relation to persistent hypothyroidism and recurrence. Sci Rep. 2019 Nov 15;9(1):16899.
  • 19. Bogazzi F, Dell'Unto E, Tanda ML, et al. Long-term outcome of thyroid function after amiodarone-induced thyrotoxicosis, as compared to subacute thyroiditis. J Endocrinol Invest. 2006 Sep;29(8):694-9.
  • 20. Bai CF, Shen GH, Yang Y, et al. Correction to: Subacute thyroiditis during early pregnancy: a case report and literature review. BMC Pregnancy Childbirth. 2022 Jan 31;22(1):86. Erratum for: BMC Pregnancy Childbirth. 2022 Jan 7;22(1):19.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm ORİJİNAL MAKALELER / ORIGINAL ARTICLES
Yazarlar

Melisa Şahin Tekin 0000-0002-4077-7258

Göknur Yorulmaz 0000-0001-8596-9344

Yayımlanma Tarihi 29 Eylül 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 44 Sayı: 5

Kaynak Göster

Vancouver Şahin Tekin M, Yorulmaz G. A Single-Center Experience in the Diagnosis and Treatment of Subacute Thyroiditis: Should Steroids Always Be the First Choice?. Osmangazi Tıp Dergisi. 2022;44(5):715-21.


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