(15.05) Useful role of C-reactive protein- in guiding glucocorticoid treatment in sub-acute thyroiditis.

C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are useful indicators of inflammation in patients with sub-acute thyroiditis (SAT), CRP has not been objectively  studied in this field. We tried  to examine whether either  CRP or  ESR, can {i} discriminate between ‘glucocorticoid requiring’ and ‘non requiring  type of inflammation, and,{ii}help clinicians to come to a decision point or not.

Methods:

Glucocorticoid treatment was based upon internationally accepted standards for the treatment of patients with SAT. The  author who initiated such therapy was unaware of the CRP or ESR level of the index patient. Another author  independently performed tests for CRP & ESR,   unaware of the modality of treatment (glucocorticoid, NSAID)

Results:

28 patients with SAT,with mmean±SD;range (years)= 37.96±8.53(20-55),12male, 16 females, were studied.The mean CRP value(mg/L) in patients requiring glucocorticoids was significantly higher than in those not requiring the drug 41.73±33.55 vs.11.20±15.41). . The ROC curves indicated that the optimal positivity criterion was 19.3 mg/L for the CRP level and 46 mm at the 1st hour for ESR. CRP with a sensitivity of 0.67, a specificity of 0.92, a positive likelihood ratio of 8.67, and an accuracy of 0.64 appeared better than ESR, which showed a sensitivity of 0.93, a specificity of 0.53, a positive likelihood ratio of 2.02, and an accuracy of 0.60.

Discussion/Conclusion:

Serum CRP level provided a clear advantage over ESR in the assessment of the severity of inflammation before initiation of glucocorticoid therapy in SAT.