甲状腺内注射地塞米松和口服泼尼松治疗亚急性甲状腺炎

Comparison of oral prednisone and intrathyroidal injection of dexamethasone in treatment of patients with subacute thyroiditis

目的 :比较口服泼尼松和甲状腺内注射地塞米松治疗亚急性甲状腺炎的疗效及两种疗法对肾上腺皮质功能的影响。方法 :6 0例亚急性甲状腺炎患者随机分为 2组 ,Dex组 (30例 )予地塞米松注射液 (5mg ,每周 2次 ,有效病例 2周后每周 1次 )甲状腺内注射 ,Pre组 (30例 )口服泼尼松 (30mg/d 2周 ,2 0mg/d 2周 ,以后每周减 5mg/d) ,治疗后 4周、6周、8周比较 2组疗效。两组于治疗前及治疗结束后 2 4h、2周及以后每 4周进行快速促肾上腺皮质激素刺激试验至肾上腺皮质功能正常 (血清皮质醇水平≥ 5 5 2nmol/L)。 结果 :8周时Dex组治愈率为 10 0 % ,Pre组治愈率 90 %。所有病例均于 10周内治愈。Dex组疗程为 (5 .7± 2 .0 )周 ,Pre组为 (8.8± 1.8)周 (P <0 .0 5 )。两组所有患者治疗前肾上腺皮质功能均正常 ;治疗结束后 2 4h明显受抑制 ;Dex组于治疗结束后 2周、4周和 8周各有 2 0例、8例和 2例恢复正常 ,Pre组于治疗结束后 2周、4周、8周和 16周各有 5例、14例、7例和 4例恢复正常 (P <0 .0 1)。 结论 :甲状腺内注射地塞米松治疗亚急性甲状腺炎较口服泼尼松改善症状和体征快 ,疗程短 。

Objective:To compare efficacy and time course of adrenocortical function recovery of oral prednisone and intrathyroidal injection of dexamethasone in patients with subacute thyroiditis. Methods: Sixty patients with subacute thyroiditis were divided randomly into 2 groups. Patients in group Dex (30 cases) were treated with intrathyroidal injection of dexamethasone (5 mg,twice per week,and then once per week.). Patients in group Pre (30 cases) were treated with prednisone. Prednisone was orally given in decreasing doses: 30 mg for the first 2 weeks, 20 mg for 2 weeks, thereafter the dose was tapered by 5 mg per week. Clinical outcomes of 2 groups were compared after 2 weeks, 4 weeks,6 weeks and 8 weeks of treatment. Rapid corticotropin stimulation test was used to assess adrenocortical function. A positive response, indicative of normal adrenocortical function,has been defined as a 30 min stimulated cortisol level of more than 552 nmol/L.The initial stimulation test was performed as a baseline study immediately following the diagnosis of subacute thyroiditis,before the initiation of glucocorticoid therapies. The tests were repeated 24 h after completion of glucocorticoid course and 2 weeks and every 4 weeks thereafter until a stimulated cortisol level of more than 552 nmol/L was achieved. Results: Curative rate of group Dex and group Pre after 8 weeks were 100% and 90% respectively. Duration of therapy was (5.7±2.0) weeks in group Dex and (8.8±1.8) weeks in group Pre respectively ( P <0.05). All 60 patients had normal adrenocortical function before prednisone or dexmethasone therapy and suppressed adrenocortical responses 24 h after completing therapies. Among 30 patients of group Dex, 20 patients had returned to normal adrenal function by 2 weeks after completing dexamethasone therapy, 8 patients by 4 weeks and 2 patients by 8 weeks; among 30 patients of group Pre,5 patients had recovered appropriate adrenal secretion of cortisol by 2 weeks after completing prednisone therapy,14 patients by 4 weeks,7 patients by 8 weeks and 4 patients by 16 weeks( P <0.01). No other adverse reactions occurred in both groups. Conclusion: Intrathyroidal injection of dexamethasone in patients with subacute thyroiditis improves the symptoms and signs more rapidly and shortened time course of recovery of suppressed adrenocortical function compared with oral prednisone therapy.