The role of intravenous methylprednisolone immunosuppression in the management of active thyroid eye disease.
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.
Tambe
Katya
K
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
Bhargava
Jonathan
J
Tripathi
Ajay
A
Gregory
Marelena
M
Burns
Joyce
J
Sampath
Raghavan
R
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
D005938:Glucocorticoids; D008775:Methylprednisolone