Efficacy and safety of intrathyroidal dexamethasone therapy in severe subacute thyroiditis - a real-world prospective single center study.

Introduction: Clinically severe subacute thyroiditis (SAT) requires high cumulative doses of systemic steroids. The aim of the DLISAT study was to assess efficacy and safety of intrathyroidal dexamethasone and lidocaine injections (DLI) in comparison to standard oral steroid therapy. Methods: A total number of 60 patients were included in the study, among whom 30 were treated with DLI (study group, SG) and 30 were treated with oral prednisone (control group, CG). In all SG patients, a dose of 4mg of dexamethasone with 1 ml of 2% lidocaine, was injected into each affected thyroid lobe. On the basis of clinical and biochemical results, the doses were repeated every 2-5 days. Results: Excellent response was observed in all SG patients, with no side effects except for injection-related discomfort. After the first injection, pain decrease and improvement in ESR, CRP, and thyroid parameters were observed. The mean cumulative dose of dexamethasone was 49.7 mg. The mean therapy period was 26.4 days. In CG, the mean therapy period was 118.9 days and the cumulative dose was 255.2 mg (1702.17 mg of prednisone). Conclusion: DLI was demonstrated to be significantly more beneficial than standard oral steroid therapy, which is especially important for patients with high risk of steroid-related complications.