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Intrathyroidal dexamethasone injection improves clinical efficacy and shortens remission time in subacute thyroiditisIntrathyroidal injection shows better results for subacute thyroiditis

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Key Takeaway
Consider intrathyroidal dexamethasone over oral prednisone for superior efficacy and faster symptom resolution in subacute thyroiditis.

This network meta-analysis evaluated the efficacy of intrathyroidal dexamethasone, both as a monotherapy and in combination with lidocaine, compared to oral prednisone for the treatment of subacute thyroiditis. The analysis focused on clinical efficacy, remission time of symptoms including fever, pain, and thyroid enlargement, and recurrence rates.

The authors synthesized evidence showing that intrathyroidal injection significantly increased clinical efficacy and significantly shortened the remission time of clinical symptoms compared to oral prednisone. When comparing the two intrathyroidal protocols, no difference was detected between dexamethasone monotherapy and dexamethasone combined with lidocaine.

Rankings based on SUCRA values indicated that monotherapy was optimal for recurrence rate (79.9%), remission time of fever (83.6%), pain of thyroid (92.5%), and adverse reactions (87.1%). Conversely, combination therapy was ranked optimal for clinical efficacy (80.0%) and remission time of thyroid enlargement (93.7%).

Clinical practice implications suggest that intrathyroidal dexamethasone is superior to oral prednisone for subacute thyroiditis. While monotherapy is recommended over combination therapy because combination therapy does not produce additional therapeutic benefits, the evidence for this specific preference is based on ranking metrics.

How this fits prior evidence

This finding addresses a gap in the management of subacute thyroiditis by comparing local and systemic steroid delivery. While previous coverage has addressed other inflammatory conditions like polymyalgia rheumatica and antisynthetase syndrome, this study specifically addresses the efficacy of intrathyroidal dexamethasone versus oral prednisone. The study confirms that intrathyroidal injection is superior to oral prednisone for both efficacy and speed of symptom resolution.

Living with subacute thyroiditis can be painful. This condition causes inflammation of the thyroid gland, often leading to significant pain, fever, and swelling in the neck. While many patients are treated with oral prednisone, new data suggests a different approach might work better for those seeking relief.

Researchers compared oral prednisone to an intrathyroidal injection of dexamethasone. They found that the local injection was more effective than the oral medication. Specifically, the injection helped patients reach remission—the point where fever, pain, and swelling subside—much faster than the oral treatment did.

When looking at different ways to give the injection, the study found no difference between using dexamethasone alone or combining it with lidocaine. While combination therapy was ranked well for specific goals like reducing swelling, the study suggests that using dexamethasone alone is sufficient. It provides the necessary benefits without adding extra steps.

What this means for you:
Injecting dexamethasone directly into the thyroid is more effective and faster than taking oral prednisone.

Common questions

Is an injection better than oral pills for thyroiditis?

Yes, the study found that an intrathyroidal injection of dexamethasone significantly increased clinical efficacy compared to oral prednisone. It also helped patients reach remission from symptoms like fever, pain, and swelling much faster than the oral medication did.

Should lidocaine be added to the injection?

The study found no difference between using dexamethasone alone and combining it with lidocaine. While combination therapy was ranked well for some specific outcomes, it did not provide additional therapeutic benefits over using dexamethasone alone.

How quickly does the injection work?

The study found that an intrathyroidal injection significantly shortened the time it took for patients to reach remission from fever, thyroid pain, and thyroid enlargement compared to taking oral prednisone.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BACKGROUND: Intrathyroidal injection of dexamethasone (Dex) alone (monotherapy) or combined Dex with lidocaine (combination therapy) has been used for treating subacute thyroiditis (SAT). We performed this study to simultaneously determine whether intrathyroidal injection of Dex was better than oral prednisone and whether combination therapy was superior to monotherapy. METHODS: We identified studies from PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), and Wanfang databases through December 31, 2021. Clinical efficacy, recurrence rate, adverse reactions, and remission time of clinical symptoms including fever, pain of thyroid and thyroid enlargement were assessed. The surface under the cumulative ranking curve (SUCRA) was estimated to determine the rank probabilities, and radar plot was to determine the optimal protocol. STATA 14 was utilized for data analysis. RESULTS: Twenty-three studies were included. Results revealed that, compared with oral prednisone, intrathyroidal injection significantly increased clinical efficacy and shortened remission time of clinical symptoms. However, no difference between the 2 protocols of intrathyroidal injection of prednisone was detected. Radar plot suggested that monotherapy might be the optimal protocol for recurrence rate (79.9%), remission time of fever (83.6%) and pain of thyroid (92.5%), and adverse reactions (87.1%); however, combination therapy for clinical efficacy (80.0%) and remission time of thyroid enlargement (93.7%). CONCLUSION: Intrathyroidal injection of Dex is better than oral prednisone for treating SAT, and monotherapy should be recommended over combination therapy because combination therapy do not produce additional therapeutic benefits.
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