Network meta-analysis of intrathyroidal injection of combined dexamethasone with lidocaine for subacute thyroiditis.

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.