{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:36Z","timestamp":1784557056213,"version":"3.55.0"},"reference-count":26,"publisher":"Bioscientifica","issue":"11","license":[{"start":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:00:00Z","timestamp":1694044800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["ec.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,9,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The optimal corticosteroid treatment regimen for subacute thyroiditis has not yet been established. To avoid side effects, tapering of the initial dose of corticosteroid is recommended. With reducing dose, the symptoms can recur.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>In a prospective clinical study, a 30-day methylprednisolone (MPSL) treatment protocol with a starting dose of 24 mg\/day and tapered by 4 mg every 5 days was assessed for effectiveness and safety regarding possible adrenal insufficiency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Fifty-nine patients with subacute thyroiditis were included. At visit 1, after establishing the diagnosis, a short stimulation adrenocorticotrophic hormone (ACTH) test was performed and methylprednisolone treatment was prescribed. At visit 2 (40 \u00b1 5 days after visit 1), clinical, laboratory (including short stimulation ACTH test), and ultrasound evaluation were repeated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty-eight patients (81.4%) were cured by the prescribed protocol, having significantly lower cortisol levels after stimulation at visit 1 than patients who were not cured (mean, 674.9 nmol\/L and 764.0 nmol\/L, respectively,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.012). Seven patients (12.3%) developed adrenal insufficiency; this group had significantly lower cortisol levels after stimulation at visit 1 than patients without adrenal insufficiency development (mean, 561.5 nmol\/L and 704.7 nmol\/L, respectively,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.005). Using stimulated cortisol level at visit 1 as the explanatory variable, logistic models were optimized to determine treatment efficacy (AUC\u2009=\u20090.745, optimal threshold 729 nmol\/L, specificity 71%, sensitivity 73%) and adrenal function (AUC\u2009=\u20090.861, optimal threshold 629 nmol\/L, specificity 73%, sensitivity 100%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The described protocol was efficient for more than 80% of patients. Using this protocol, the corticosteroid treatment interval is shorter than proposed in current guidelines.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance statement<\/jats:title>\n                    <jats:p>A short but effective protocol for treatment of subacute thyroiditis with methylprednisolone is presented in this article. Using this protocol, the treatment interval is shorter than proposed in current guidelines. Its safety regarding possible adrenal insufficiency is assessed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1530\/ec-23-0054","type":"journal-article","created":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T06:47:36Z","timestamp":1694069256000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-10","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy and safety of a 30-day methylprednisolone treatment protocol for subacute thyroiditis: a prospective study"],"prefix":"10.1530","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2296-368X","authenticated-orcid":true,"given":"Katica","family":"Bajuk Studen","sequence":"first","affiliation":[{"name":"Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Gaber\u0161\u010dek","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edvard","family":"Pirnat","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nata\u0161a","family":"Bedernjak Bajuk","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreja","family":"Vendramin","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Majcen","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, SB Celje, Celje, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Zaletel","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Thyroid","first-page":"1343","article-title":"2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis","volume":"26","author":"Ross","year":"2016","unstructured":"Ross DSBurch HBCooper DSGreenlee MCLaurberg PMaia ALRivkees SASamuels MSosa JAStan MN, 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid2016261343\u20131421. (https:\/\/doi.org\/10.1089\/thy.2016.0229)"},{"key":"bib2","series-title":"Reviews in Endocrine and Metabolic Disorders","first-page":"1027","article-title":"New aspects in the pathogenesis and management of subacute thyroiditis","volume":"22","author":"Stasiak","year":"2021","unstructured":"Stasiak M & Lewi\u0144ski A. New aspects in the pathogenesis and management of subacute thyroiditis. Reviews in Endocrine and Metabolic Disorders2021221027\u20131039. (https:\/\/doi.org\/10.1007\/s11154-021-09648-y)"},{"key":"bib3","series-title":"Endocrine Practice","first-page":"594","article-title":"The evaluation of low- and high-dose steroid treatments in subacute thyroiditis: a retrospective observational study","volume":"27","author":"Hepsen","year":"2021","unstructured":"Hepsen SAkhanli PSencar MEDuger HSakiz DKizilgul MOzturk Unsal IUcan BOzbek M & Cakal E. The evaluation of low- and high-dose steroid treatments in subacute thyroiditis: a retrospective observational study. Endocrine Practice202127594\u2013600. (https:\/\/doi.org\/10.1016\/j.eprac.2020.11.009)"},{"key":"bib4","series-title":"Thyroid","first-page":"269","article-title":"Initial Treatment with 15\u2009mg of prednisolone Daily Is Sufficient for Most Patients with Subacute Thyroiditis in Japan","volume":"23","author":"Kubota","year":"2013","unstructured":"Kubota SNishihara EKudo TIto MAmino N & Miyauchi A. Initial Treatment with 15\u2009mg of prednisolone Daily Is Sufficient for Most Patients with Subacute Thyroiditis in Japan. Thyroid201323269\u2013272. (https:\/\/doi.org\/10.1089\/thy.2012.0459)"},{"key":"bib5","series-title":"Endocrine","first-page":"209","article-title":"Comparison of the therapeutic effects of prednisolone and nonsteroidal anti-inflammatory drugs in patients with subacute thyroiditis","volume":"55","author":"Sato","year":"2017","unstructured":"Sato JUchida TKomiya KGoto HTakeno KSuzuki RHonda AHimuro M & Watada H. Comparison of the therapeutic effects of prednisolone and nonsteroidal anti-inflammatory drugs in patients with subacute thyroiditis. Endocrine201755209\u2013214. (https:\/\/doi.org\/10.1007\/s12020-016-1122-3)"},{"key":"bib6","series-title":"Trials","first-page":"418","article-title":"Comparison of the therapeutic effects of 15 mg and 30 mg initial dosage of prednisolone daily in patients with subacute thyroiditis: protocol for a multicenter, randomized, open, parallel control study","volume":"21","author":"Xu","year":"2020","unstructured":"Xu SJiang YJia AZhang JGao BXu JJing XJiao YWei JXu W, Comparison of the therapeutic effects of 15 mg and 30 mg initial dosage of prednisolone daily in patients with subacute thyroiditis: protocol for a multicenter, randomized, open, parallel control study. Trials202021418. (https:\/\/doi.org\/10.1186\/s13063-020-04337-8)"},{"key":"bib7","series-title":"Journal of UOEH","first-page":"103","article-title":"Prednisolone dosing regimen for treatment of subacute thyroiditis","volume":"37","author":"Arao","year":"2015","unstructured":"Arao TOkada YTorimoto KKurozumi ANarisawa MYamamoto S & Tanaka Y. Prednisolone dosing regimen for treatment of subacute thyroiditis. Journal of UOEH201537103\u2013110. (https:\/\/doi.org\/10.7888\/juoeh.37.103)"},{"key":"bib8","series-title":"Endocrine Practice","first-page":"900","article-title":"Short-term versus 6-week prednisone in the treatment of subacute thyroiditis: a randomized controlled trial","volume":"26","author":"Duan","year":"2020","unstructured":"Duan LFeng XZhang RTan XXiang XShen R & Zheng H. Short-term versus 6-week prednisone in the treatment of subacute thyroiditis: a randomized controlled trial. Endocrine Practice202026900\u2013908. (https:\/\/doi.org\/10.4158\/EP-2020-0096)"},{"key":"bib9","series-title":"Journal of Clinical Endocrinology and Metabolism","first-page":"2171","article-title":"Adrenal insufficiency in corticosteroids use: systematic review and meta-analysis","volume":"100","author":"Broersen","year":"2015","unstructured":"Broersen LHAPereira AMJ\u00f8rgensen JOL & Dekkers OM. Adrenal insufficiency in corticosteroids use: systematic review and meta-analysis. Journal of Clinical Endocrinology and Metabolism20151002171\u20132180. (https:\/\/doi.org\/10.1210\/jc.2015-1218)"},{"key":"bib10","series-title":"European Journal of Internal Medicine","first-page":"714","article-title":"Why glucocorticoid withdrawal may sometimes be as dangerous as the treatment itself","volume":"24","author":"Dinsen","year":"2013","unstructured":"Dinsen SBaslund BKlose MRasmussen AKFriis-Hansen LHilsted L & Feldt-Rasmussen U. Why glucocorticoid withdrawal may sometimes be as dangerous as the treatment itself. European Journal of Internal Medicine201324714\u2013720. (https:\/\/doi.org\/10.1016\/j.ejim.2013.05.014)"},{"key":"bib11","series-title":"American Journal of Medicine","first-page":"258","article-title":"Recovery of the hypothalamic-pituitary-adrenal (HPA) axis in patients with rheumatic diseases receiving low-dose prednisone","volume":"95","author":"LaRochelle","year":"1993","unstructured":"LaRochelle GELaRochelle AGRatner RE & Borenstein DG. Recovery of the hypothalamic-pituitary-adrenal (HPA) axis in patients with rheumatic diseases receiving low-dose prednisone. American Journal of Medicine199395258\u2013264. (https:\/\/doi.org\/10.1016\/0002-9343(9390277-v)"},{"key":"bib12","series-title":"European Journal of Epidemiology","first-page":"1045","article-title":"Oral glucocorticoid therapy and all-cause and cause-specific mortality in patients with rheumatoid arthritis: a retrospective cohort study","volume":"31","author":"Movahedi","year":"2016","unstructured":"Movahedi MCostello RLunt MPye SRSergeant JC & Dixon WG. Oral glucocorticoid therapy and all-cause and cause-specific mortality in patients with rheumatoid arthritis: a retrospective cohort study. European Journal of Epidemiology2016311045\u20131055. (https:\/\/doi.org\/10.1007\/s10654-016-0167-1)"},{"key":"bib13","series-title":"BMJ","first-page":"n1380","article-title":"Glucocorticoid induced adrenal insufficiency","volume":"374","author":"Prete","year":"2021","unstructured":"Prete A & Bancos I. Glucocorticoid induced adrenal insufficiency. BMJ2021374n1380. (https:\/\/doi.org\/10.1136\/bmj.n1380)"},{"key":"bib14","series-title":"JAMA","first-page":"671","article-title":"Glucocorticoid-induced adrenal insufficiency","volume":"282","author":"Krasner","year":"1999","unstructured":"Krasner AS. Glucocorticoid-induced adrenal insufficiency. JAMA1999282671\u2013676. (https:\/\/doi.org\/10.1001\/jama.282.7.671)"},{"key":"bib15","series-title":"Scientific Reports","first-page":"16899","article-title":"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","volume":"9","author":"Sencar","year":"2019","unstructured":"Sencar MECalapkulu MSakiz DHepsen SKus AAkhanli PUnsal IOKizilgul MUcan BOzbek M, 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. Scientific Reports2019916899. (https:\/\/doi.org\/10.1038\/s41598-019-53475-w)"},{"key":"bib16","series-title":"Clinical Therapeutics","first-page":"2216","article-title":"Long-term systemic corticosteroid exposure: a systematic literature review","volume":"39","author":"Rice","year":"2017","unstructured":"Rice JBWhite AGScarpati LMWan G & Nelson WW. Long-term systemic corticosteroid exposure: a systematic literature review. Clinical Therapeutics2017392216\u20132229. (https:\/\/doi.org\/10.1016\/j.clinthera.2017.09.011)"},{"key":"bib17","series-title":"Slovenian Medical Journal","first-page":"453","article-title":"Strokovna stali\u0161\u010da Zdru\u017eenja endokrinologov Slovenije o obravnavi glukokortikoidne osteoporoze","volume":"87","author":"Kocjan","year":"2018","unstructured":"Kocjan TSever MJ & Pre\u017eelj J. Strokovna stali\u0161\u010da Zdru\u017eenja endokrinologov Slovenije o obravnavi glukokortikoidne osteoporoze. Slovenian Medical Journal201887453\u2013460. (https:\/\/doi.org\/10.6016\/ZdravVestn.2637)"},{"key":"bib18","series-title":"Nature Reviews. Disease Primers","first-page":"19","article-title":"Adrenal insufficiency","volume":"7","author":"Hahner","year":"2021","unstructured":"Hahner SRoss RJArlt WBancos IBurger-Stritt STorpy DJHusebye ES & Quinkler M. Adrenal insufficiency. Nature Reviews. Disease Primers2021719. (https:\/\/doi.org\/10.1038\/s41572-021-00252-7)"},{"key":"bib19","series-title":"Clinical Endocrinology","first-page":"673","article-title":"Method-specific serum cortisol responses to the adrenocorticotrophin test: comparison of gas chromatography-mass spectrometry and five automated immunoassays","volume":"78","author":"El-Farhan","year":"2013","unstructured":"El-Farhan NPickett ADucroq DBailey CMitchem KMorgan NArmston AJones LEvans C & Rees DA. Method-specific serum cortisol responses to the adrenocorticotrophin test: comparison of gas chromatography-mass spectrometry and five automated immunoassays. Clinical Endocrinology201378673\u2013680. (https:\/\/doi.org\/10.1111\/cen.12039)"},{"key":"bib20","series-title":"Thyroid","first-page":"1169","article-title":"Interobserver variation for ultrasound determination of thyroid nodule volumes","volume":"15","author":"Brauer","year":"2005","unstructured":"Brauer VFHEder PMiehle KWiesner TDHasenclever H & Paschke R. Interobserver variation for ultrasound determination of thyroid nodule volumes. Thyroid2005151169\u20131175. (https:\/\/doi.org\/10.1089\/thy.2005.15.1169)"},{"key":"bib21","series-title":"Endocrine Practice","first-page":"456","article-title":"Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists","volume":"17","author":"Bahn","year":"2011","unstructured":"Bahn RSBurch HBCooper DSGarber JRGreenlee MCKlein ILaurberg PMcDougall IRMontori VMRivkees SA, Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocrine Practice201117456\u2013520. (https:\/\/doi.org\/10.4158\/ep.17.3.456)"},{"key":"bib22","series-title":"Journal of Clinical Endocrinology and Metabolism","first-page":"2100","article-title":"Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study","volume":"88","author":"Fatourechi","year":"2003","unstructured":"Fatourechi VAniszewski JPFatourechi GZEAtkinson EJ & Jacobsen SJ. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. Journal of Clinical Endocrinology and Metabolism2003882100\u20132105. (https:\/\/doi.org\/10.1210\/jc.2002-021799)"},{"key":"bib23","series-title":"Internal Medicine (Tokyo, Japan)","first-page":"292","article-title":"Evaluation of recurrence in 36 subacute thyroiditis patients managed with prednisolone","volume":"40","author":"Mizukoshi","year":"2001","unstructured":"Mizukoshi TNoguchi SMurakami TFutata T & Yamashita H. Evaluation of recurrence in 36 subacute thyroiditis patients managed with prednisolone. Internal Medicine (Tokyo, Japan)200140292\u2013295. (https:\/\/doi.org\/10.2169\/internalmedicine.40.292)"},{"key":"bib24","series-title":"Frontiers in Endocrinology (Lausanne)","first-page":"783439","article-title":"Risk factors for subacute thyroiditis recurrence: a systematic review and meta-analysis of cohort studies","volume":"12","author":"Zhang","year":"2021","unstructured":"Zhang JDing GLi JLi XDing LLi XYang S &Tang F. Risk factors for subacute thyroiditis recurrence: a systematic review and meta-analysis of cohort studies. Frontiers in Endocrinology (Lausanne)202112783439. (https:\/\/doi.org\/10.3389\/fendo.2021.783439)"},{"key":"bib25","series-title":"Frontiers in Endocrinology (Lausanne)","first-page":"918356","article-title":"High mortality rate in oral glucocorticoid users: a population-based matched cohort study","volume":"13","author":"Einarsdottir","year":"2022","unstructured":"Einarsdottir MJEkman PMolin MTrimpou POlsson DSJohannsson G & Ragnarsson O. High mortality rate in oral glucocorticoid users: a population-based matched cohort study. Frontiers in Endocrinology (Lausanne)202213918356. (https:\/\/doi.org\/10.3389\/fendo.2022.918356)"},{"key":"bib26","series-title":"International Journal of General Medicine","first-page":"6425","article-title":"Management of subacute thyroiditis: a systematic review of current treatment protocols","volume":"15","author":"Ray","year":"2022","unstructured":"Ray ID\u2019souza BSarker P & Agarwal P. Management of subacute thyroiditis: a systematic review of current treatment protocols. International Journal of General Medicine2022156425\u20136439. (https:\/\/doi.org\/10.2147\/IJGM.S366784)"}],"container-title":["Endocrine Connections"],"original-title":[],"link":[{"URL":"https:\/\/ec.bioscientifica.com\/view\/journals\/ec\/12\/11\/EC-23-0054.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/ec.bioscientifica.com\/downloadpdf\/journals\/ec\/12\/11\/EC-23-0054.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/ec.bioscientifica.com\/downloadpdf\/journals\/ec\/12\/11\/EC-23-0054.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:46:22Z","timestamp":1784555182000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/ec\/article\/1594"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,7]]},"references-count":26,"journal-issue":{"issue":"11"},"URL":"https:\/\/doi.org\/10.1530\/ec-23-0054","relation":{},"ISSN":["2049-3614"],"issn-type":[{"value":"2049-3614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,7]]}}}