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136 Likewise, acute recurrent rhinosinusitis treated with nasal douche consisting of flunisolide (corticosteroid) and N-acetylcysteine has been associated with a less stuffy nose, reduction in severity of symptoms and rhinosinus signs as assessed by endoscopy, improved cytological grading of neutrophil and eosinophil cells, less exacerbations, and increased mucociliary motility

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However, clinicians should remain vigilant for signs of excessive metabolic suppression or thyroid dysfunction, particularly in patients with pre-existing thyroid conditions or those experiencing symptoms beyond cold intolerance, such as severe fatigue, hair loss, or cognitive changes that might suggest thyroid hormone imbalance requiring investigation