New Approach in the Treatment of Subacute Thyroiditis: ECE Protocol

Subacute thyroiditis is the most common cause of painful thyroid gland disease. The disease was first described by Fritz De Quervain in 1904. It is a self-limiting disease that usually occurs after viral upper respiratory tract infection. In the pathophysiology (Table 1), the apoptosis of the follicular epithelium and the deterioration of the follicle integrity are essential. The disease rate increases in young adults and decreases in later ages. Subacute thyroiditis is 3.5-4 times more common in females than males. It is most commonly seen in August and September [1-6]. The subacute thyroiditis treatment recommendation is mostly based on clinical experience. In this presentation, we aimed to present a new approach in patients who did not recur in follow-up for at least 6 months after treatment [4].

Table 1: Subacute thyroiditis treatment with ECE protocol.

1. Check after 3 months if complete recovery is achieved. The patient should be informed about
2. recurrence.
3. If there is improvement in the laboratory but the subacute trioid is continuing clinically and
4. radiologically; monthly control with methylprednisolone 4mg x 1 maintenance treatment.
5. If the clinical improvement is not achieved after methylprednisolone within 3 days of treatment, the
6. patient should be reevaluated for differential diagnosis.
7. Metformin can be initiated with impaired fasting glucose and impaired glucose tolerance in patients
8. with dietary and lifestyle changes [5-6].
9. In patients with dyspeptic complaints, the proton pump inhibitor should be started with the treatment.
10. Iodine-restricted diet in dietician partnership.
11. Beta-blocker therapy may be given temporarily in patients with early onset tachycardia.

Patients who received ECE protocol treatment had no recurrence within 6 months. We think that ECE protocol is effective according to clinical experience..

1. Shrestha RT, Hennessey J (2015) Acute and subacute, and Riedel’s thyroiditis. In: Degroot LJ, Chrousos G, Dungan K, Feingold KR, Grossman A (Eds.), South Dartmouth, MA, USA.
2. Pearce EN, Farwell AP, Braverman LE (2003) Thyroiditis. The New England Journal of Medicine 348(26): 2646-2655.
3. Kitchener MI, Chapman IM (1989) Subacute thyroiditis: a review of 105 cases. Clin Nucl Med 14(6): 439-442.
4. Fallahi P, Ferrari SM, Ruffilli I, Elia G, BiricoC M, et al. (2016) The association of other autoimmune diseases in patients with autoimmune thyroiditis: review of the literature and report of a large series of patients. Autoimmun Rev 15(12): 1125-1128.
5. Lee YJ, Kim DW (2016) Sonographic characteristics and interval changes of subacute thyroiditis. J Ultrasound Med 35(8): 1653-1659.
6. Sato J, Uchida T, Komiya K, Goto H, Takeno K, et al. (2017) Comparison of the therapeutic effects of prednisolone and nonsteroidal anti-inflammatory drugs in patients with subacute thyroiditis. Endocrine 55(1): 209-214.