The recommended initial treatment for a patient diagnosed with De Quervain's thyroiditis who is experiencing significant pain is primarily supportive, focusing on pain relief and inflammation control. This typically involves the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation. If the pain is severe or not adequately controlled by NSAIDs, corticosteroids such as prednisolone may be considered to provide more effective symptom relief.
Beta-blockers can be used if the patient experiences symptoms of thyrotoxicosis, but antithyroid drugs are generally not indicated because the thyrotoxicosis in De Quervain's thyroiditis is due to thyroid inflammation and hormone leakage rather than hyperthyroidism from increased hormone synthesis.
This approach aligns with the NICE guideline recommendation that transient thyrotoxicosis without hyperthyroidism, such as that seen in subacute thyroiditis, usually requires only supportive treatment including pain management and beta-blockers if needed NICE NG145. Recent literature on the management of subacute (De Quervain's) thyroiditis supports this, emphasizing NSAIDs as first-line treatment and corticosteroids for more severe cases Volpé 2025.