Successful Management of Recurrent Subacute Thyroiditis by Adding Colchicine to Glucocorticoid Treatment: A Case Series Study

Abstract

Although subacute thyroiditis (SAT) is thought to be a self-limited inflammatory thyroid disease, the recurrence rate of SAT is approximately 10–20%. It is difficult for these patients to stop glucocorticoid treatment, and they are usually bothered with recurrent pain and the side effects of glucocorticoids for more than several months. We describe three cases who were diagnosed with recurrent subacute thyroiditis after a reduction in prednisolone (PSL) dose, either immediately upon the cessation of PSL or shortly thereafter. Their symptoms, including the adverse effects of PSL, severely impacted their quality of life. After a complete assessment, we administered colchicine at 1 mg per day for 1–2 months to control the recurrence of SAT and monitored their routine blood parameters every two weeks. All 3 patients were successfully tapered off of PSL treatment and were free of frequently recurrent SAT. Colchicine may be therapeutic in patients with prednisolone-refractory, recurrent SAT. However, a large-scale, double-blind, controlled, prospective multicenter study is required to provide a solid body of evidence.

Key words

recurrent subacute thyroiditis - SAT - management - colchicine - glucocorticoid

Publication History

Received: 02 July 2019

Accepted after revision: 24 March 2020

Article published online:
04 May 2020

• References

• 1 Farwell AP. Subacute thyroiditis and acute infectious thyroiditis. Philadelphia: Lippincott Williams-Wilkins Publishers; 2005: 536-547
• 2 Volpe R. The management of subacute (DeQuervain's) thyroiditis. Thyroid 1993; 3: 253-255
• 3 Nishihara E, Ohye H, Amino N. et al. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Inter Med 2008; 47: 725-729
• 4 Benbassat CA, Olchovsky D, Tsvetov G. et al. Subacute thyroiditis: clinical characteristics and treatment outcome in fifty-six consecutive patients diagnosed between 1999 and 2005. J Endocrinol Invest 2007; 30: 631-635
• 5 Engkakul P, Mahachoklertwattana P, Poomthavorn P. Eponym: de Quervain thyroiditis. Eur J Pediatr 2011; 170: 427-431
• 6 Vagenakis AG, Abreau CM, Braverman LE. Prevention of recurrence in acute thyoiditis following corticosteroid withdrawal. J Clin Endocrinol Metab 1970; 31: 705-708
• 7 Bennedbaek FN, Hegedus L. The value of ultrasonography in the diagnosis and follow-up of subacute thyroiditis. Thyroid 1997; 7: 45-50
• 8 Mizukoshi T, Noguchi S, Murakami T. et al. Evaluation of recurrence in 36 subacute thyroiditis patients managed with prednisolone. Inter Med 2001; 40: 292-295
• 9 Volper R. The Management of Subacute (DeQuervain’s) Thyroiditis. Thyroid 1993; 3: 253-255
• 10 Ross DS, Burch HB, Cooper DS. et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016; 26: 1343-13421
• 11 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; 23: 269-272
• 12 Koirala KP, Sharma V. Treatment of acute painful thyroiditis with low dose prednisolone: A study on patients from Western Nepal. J Clin Diagnos Res 2015; 9: MC01-MC03
• 13 Endocrinology tCSo 2008 Chinese Society of Endocrinology guidelines for diagnosis and management of subacute thyroiditis. Chin J Intern Med 2008; 47: 784-784
• 14 de Castro IF, Volonte L, Risco C. Virus factories: biogenesis and structural design. Cell Microbiol 2013; 15: 24-34
• 15 Netherton CL, Wileman TE. African swine fever virus organelle rearrangements. Virus Res 2013; 173: 76-86
• 16 Cohen CJ, Shieh JT, Pickles RJ. et al. The coxsackievirus and adenovirus receptor is a transmembrane component of the tight junction. Proc Natl Acad Sci USA 2001; 98: 15191-15196
• 17 Sollerbrant K, Raschperger E, Mirza M. et al. The coxsackievirus and adenovirus receptor (CAR) forms a complex with the PDZ domain-containing protein ligand-of-numb protein-X (LNX). J Biol Chem 2003; 278: 7439-7444
• 18 Coyne CB, Voelker T, Pichla SL. et al. The coxsackievirus and adenovirus receptor interacts with the multi-PDZ domain protein-1 (MUPP-1) within the tight junction. J Biol Chem 2004; 279: 48079-48084
• 19 Cuartas-Lopez AM, Hernandez-Cuellar CE, Gallego-Gomez JC. Disentangling the role of PI3K/Akt, Rho GTPase and the actin cytoskeleton on dengue virus infection. Virus Res 2018; 256: 153-165
• 20 Hou Jin-li SY, Song Y, Duan M. et al. Effects of cytoskeleton inhibitors on rabies virus infection in human neuroblastoma. Cells. J Jilin Agric Univ 2014; 36: 176-1782
• 21 Antonopoulos AS, Papanikolaou E, Vogiatzi G. et al. Anti-inflammatory agents in peripheral arterial disease. Curr Opin Pharmacol 2018; 39: 1-8
• 22 Drenth JP, van der Meer JW. The inflammasome–a linebacker of innate defense. N Engl J Med 2006; 355: 730-732
• 23 Wang Y, Viollet B, Terkeltaub R. et al. AMP-activated protein kinase suppresses urate crystal-induced inflammation and transduces colchicine effects in macrophages. Ann Rheum Dis 2016; 75: 286-294
• 24 Roubille F, Kritikou E, Busseuil D. et al. Colchicine: an old wine in a new bottle?. Antiinflam Antiallerg Agents Med Chem 2013; 12: 14-23
• 25 Robertson S, Martinez GJ, Payet CA. et al. Colchicine therapy in acute coronary syndrome patients acts on caspase-1 to suppress NLRP3 inflammasome monocyte activation. Clin Sci 2016; 130: 1237-1246
• 26 Li JJ, Lee SH, Kim DK. et al. Colchicine attenuates inflammatory cell infiltration and extracellular matrix accumulation in diabetic nephropathy. Am J Physiol Renal Physiol 2009; 297: F200-F209
• 27 Disel U, Paydas S, Dogan A. et al. Effect of colchicine on cyclosporine nephrotoxicity, reduction of TGF-beta overexpression. apoptosis, and oxidative damage: an experimental animal study. Transpl Proc 2004; 36: 1372-1376