title: The role of intravenous methylprednisolone immunosuppression in the management of active thyroid eye disease.
abstract: OBJECTIVE
  To analyze the efficacy of intravenous methylprednisolone (IVMP) immunosuppression in the management of active thyroid eye disease (TED).
  
  
  METHODS
  This is a consecutive case series of 36 patients treated with 1 g of IVMP over 3 days, between January 2000 and January 2008. The indications for this treatment were moderate to severe active TED with or without optic nerve compression.
  
  
  RESULTS
  There were 32 hyperthyroid, 2 hypothyroid, and 2 euthyroid patients in this series. Nine patients presented with optic nerve compromise, 3 had severe active TED and 24 had moderately active TED. Twenty-seven patients received one course of IVMP and nine patients received two courses. All patients had tapering oral prednisolone over 1 month following the IVMP. The mean improvement in proptosis was 1.31 mm (range = 0-3 mm). Optic nerve function improved in seven of nine patients (77.8%). Extra ocular muscle movement improved in 18 patients (50%). Overall benefit from IVMP was seen at 1/12 in 27 patients (75%) and at 3/12 in 30 patients (83%). After IVMP one patient underwent radiotherapy and three patients had nonsteroidal immunosuppression.
  
  
  CONCLUSIONS
  IVMP immunosuppression is effective in 83% of patients. The effect lasts from 3 months to 8 years, with a mean of 15 months in 30.5%. It remains a useful modality of treatment especially when the optic nerve or cornea is threatened because of moderate to severe active TED. We encountered no severe side effects of pulsed IVMP and 3 g over 3 days is a safe dose.
authors.affiliation: Lid, Lacrimal and Orbit Service, Department of Ophthalmology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK. katya.tambe@gmail.com
authors.forename: Katya
authors.initials: K
authors.lastname: Tambe
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bhargava
authors.forename: Ajay
authors.initials: A
authors.lastname: Tripathi
authors.forename: Marelena
authors.initials: M
authors.lastname: Gregory
authors.forename: Joyce
authors.initials: J
authors.lastname: Burns
authors.forename: Raghavan
authors.initials: R
authors.lastname: Sampath
mesh_terms: D005094:Exophthalmos / Q000188:drug therapy / Q000503:physiopathology; D005938:Glucocorticoids / Q000008:administration & dosage*; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007165:Immunosuppression Therapy; D007262:Infusions, Intravenous; D008775:Methylprednisolone / Q000008:administration & dosage*; D009801:Oculomotor Muscles / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids; D008775:Methylprednisolone