title: Clinical and imaging evaluation of the response to intravenous steroids in patients with Graves' orbitopathy and analysis on who requires additional therapy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the safety and efficacy of an individualized steroid regimen in patients with moderate-to-severe Graves' orbitopathy (GO) by monitoring clinical and imaging parameters.
  
  
  METHODS
  In total, 47 patients with active, moderate-to-severe GO were enrolled in this study. All the patients received the proposed treatment regimen by European Group on GO of 4.5 g of intravenous (IV) methylprednisolone for 12 weeks. At the end of the IV treatment, patients with persistent active GO (Group 1) who were assessed by clinical examination and orbital imaging with short tau inversion recovery-sequence magnetic resonance imaging (STIR MRI) received additional treatment with oral prednisolone, and those with inactive GO (Group 2) received no further treatment.
  
  
  RESULTS
  Of the 42 patients who completed the study, 22 (52.4%) patients formed Group 1 and 20 (47.6%) patients Group 2. At the 12th week, the overall response to IV treatment was 76.2%, and clinical activity score (CAS) improvement was 69%. At the 24th week, the overall response was 92.8%, and CAS improvement was 97.6%, without statistically significant difference in CAS and total eye score between these two groups (P=0.157 andP=0.856, respectively). Ophthalmic manifestations were improved, being absent or minimal in 78.6% of patients at the 24th week follow-up. Recurrence of disease activity occurred in 9.5% of patients up to 24 weeks after the completion of treatment, and major adverse events occurred in 6.4% of patients.
  
  
  CONCLUSIONS
  In patients with moderate-to-severe GO, IV steroid treatment, followed by oral treatment, when needed, is an effective regimen with low rates of adverse events and recurrences. STIR MRI is a significant tool for recognizing patients who need additional steroid treatment.
authors.affiliation: Department of Ophthalmology, University Hospital of Larissa, Larissa.
authors.forename: Theodora
authors.initials: T
authors.lastname: Tsirouki
authors.affiliation: Department of Endocrinology, University Hospital of Larissa, Larissa.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bargiota
authors.affiliation: Department of Endocrinology, University Hospital of Ioannina, Ioannina.
authors.forename: Stelios
authors.initials: S
authors.lastname: Tigas
authors.affiliation: Department of Endocrinology, University Hospital of Larissa, Larissa.
authors.forename: Agathi
authors.initials: A
authors.lastname: Vasileiou
authors.affiliation: Department of Diagnostic Radiology, University Hospital of Larissa, Larissa.
authors.forename: Eftichia
authors.initials: E
authors.lastname: Kapsalaki
authors.affiliation: Department of Endocrinology, University Hospital of Ioannina, Ioannina.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Giotaki
authors.affiliation: Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Asproudis
authors.affiliation: Department of Endocrinology, University Hospital of Ioannina, Ioannina.
authors.forename: Agathokles
authors.initials: A
authors.lastname: Tsatsoulis
authors.affiliation: Department of Endocrinology, University Hospital of Larissa, Larissa.
authors.forename: Georgios
authors.initials: G
authors.lastname: Koukoulis
authors.affiliation: Department of Ophthalmology, University Hospital of Larissa, Larissa.
authors.forename: Evangelia E
authors.initials: EE
authors.lastname: Tsironi
keywords: Graves’ orbitopathy; MRI; glucocorticoids; magnetic resonance imaging