The Effects of Corticosteroid and Nonsteroid Anti-Inflammatory Therapies on Permanent Hypothyroidism Occurring After the Subacute Thyroiditis

ABSTRACT

Objective

Subacute thyroiditis(SAT) is an acute inflammatory, self-limited, and destructive disease of the thyroid gland. Although it is a temporary disease, it has permanent consequences. We aim to investigate the influences of the treatment choice on permanent hypothyroidism occurring after SAT and whether there are predictive factors for the development of permanent hypothyroidism.

Methods

We retrospectively investigated 57 SAT patients admitted to our tertiary hospital between 2017 and 2019. After excluding 6 patients, demographic, clinical, laboratory, and imaging findings of 36 patients treated with NSAIDs and 15 patients treated with corticosteroids were compared. The median duration of follow-up was 4 (3.5-5.5) years.

Results

Permanent hypothyroidism occurred in 16 patients (31.4%) of 51 patients. It developed at a significantly higher rate in NSAID users (p=0.019). There was no significant difference in the occurrence of transient hypothyroidism and recurrence (p=0.472, p=0.082). The early maximum TSH values were strongly associated with permanent hypothyroidism. The Odds Ratio (OR) value was 2.59 (95% CI = 1.26 – 5.33, p=0.009), Nagelkerke R2 = 0.821. The early maximum TSH level had a predictive value, with an AUC of 0.966 for post-SAT permanent hypothyroidism (p<0.001). The cutoff values for the early maximum TSH were 9.07uIU/ml (81.3% sensitivity, 100% specificity), and 7.05 uIU/ml (87.5% sensitivity, 94.3% specificity).

Conclusion

Corticosteroid therapy is significantly effective in preventing permanent hypothyroidism from developing after SAT. The early maximum TSH values are an indicator for the prediction of the development of permanent hypothyroidism.

KEYWORDS:

• Corticosteroid
• non-steroid anti-inflammatory drug
• permanent hypothyroidism
• subacute thyroiditis

Acknowledgments

We thank Dr. Serhat Ozcelik, all hospital officials and employees of Kartal Dr. Lutfi Kirdar City Hospital, and the patients featured in our study.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Ethics Approval

The study was conducted in agreement with the Declaration of Helsinki II and was approved by Kartal Dr. Lutfi Kirdar City Hospital Ethical Committee (reference number: 2022/514/240/13, date: 28.12.2022).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.