To evaluate the usefulness of monitoring serum sialic acid (SA) levels for diagnosis and follow-up of subacute granulomatous thyroiditis (SAT), 43 patients were studied at our clinic. In the acute phase of the disease their SA levels averaged 104.9 +/- 19.7 mg/dl (normal 44-69 mg/dl). In the recovery phase SA levels returned to a range of 60.5 +/- 6.9 mg/dl. However, an increase in SA (87.4 +/- 18.2 mg/dl) was detected at the time of recurrence in 14 patients. In 29 non-recurrent patients, serum SA gradually reduced during the course of therapy and normalized in all patients by the time glucocorticoid therapy was discontinued. Thyroglobulin (Tg) and the erythrocyte sedimentation rate (ESR), however, had normalized in only half the cases even at the time of cessation of therapy (Tg 5/11, ESR 4/8). C-reactive protein (CRP) returned to negative in most patients (19/24) only one week after initiation of the therapy. These results suggested that the monitoring of SA levels can be a useful tool in diagnosis and follow-up of SAT.