Healthcare-seeking behavior and treatment approaches prior to the diagnosis of subacute thyroiditis: a retrospective study from a tertiary center

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Abstract
Aims: Subacute thyroiditis (SAT) is a self-limiting inflammatory thyroid disorder that frequently presents with neck pain, systemic symptoms, and biochemical thyrotoxicosis. Delayed recognition of SAT may lead to repeated healthcare visits, inappropriate antibiotic use, and postponement of appropriate treatment. This study aimed to evaluate healthcare-seeking behavior, referral patterns, antibiotic use, and treatment approaches among patients diagnosed with SAT at a tertiary referral center. Additionally, demographic characteristics of patients diagnosed during the study period were assessed. Methods: In this retrospective cross-sectional study, medical records of patients evaluated for SAT in the Endocrinology Department of Sincan Training and Research Hospital between June 2023 and March 2025 were reviewed. Among 117 identified cases, 100 patients with confirmed SAT and complete clinical data were included in the analysis. Demographic characteristics, departments visited before endocrinology referral, time from symptom onset to endocrinology evaluation, antibiotic use, laboratory findings, thyroid ultrasonography results, and treatment methods were analyzed. Results: The study population consisted predominantly of female (74%), with a mean age of 45.4±9.9 years. The mean interval between symptom onset and endocrinology referral was 23.7±17.3 days. Prior to endocrinology evaluation, patients most frequently presented to internal medicine (45.6%) and otorhinolaryngology (14.4%) clinics. Notably, some patients sought care from multiple specialties, including emergency departments. Elevated inflammatory markers were observed at presentation, with mean erythrocyte sedimentation rate and C-reactive protein levels of 52.7±30.8 mm/h and 7.9±18.0 mg/dl, respectively. Before receiving a diagnosis of SAT, 42% of patients had been prescribed antibiotics, most commonly cephalosporins and amoxicillinclavulanate. Typical ultrasonographic findings of SAT were present in 80% of patients. Following diagnosis, the most frequently prescribed treatment regimen was a combination of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids (42%), followed by NSAID monotherapy (27%) and corticosteroid monotherapy (26%). Conclusion: A substantial proportion of patients with SAT underwent evaluation by multiple healthcare providers and received unnecessary antibiotic treatment before referral to endocrinology services. These findings underscore the continuing challenges in early recognition of SAT and the importance of increasing clinical awareness, particularly among first-contact healthcare providers. Earlier identification of SAT may reduce diagnostic delays, minimize inappropriate antibiotic use, and facilitate timely initiation of appropriate therapy.
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