Endocrine Abstracts

High dose steroids are effective in treating active thyroid-associated ophthalmopathy (TAO), however the side effects are considerable. This study aimed to establish whether long term response to intravenous methylprednisolone can be predicted by a detailed ophthalmological assessment 1 to 2 weeks after the first dose of steroid.

45 patients with moderate to severe, active TAO (including 31 with optic neuropathy), treated with intravenous methylprednisolone were studied. Ophthalmological parameters were noted immediately before treatment, 1 to 2 weeks after treatment and at a year follow up. Early response was compared to severity of disease at a year using paired t-tests and Wilcoxon sum tests. In addition to high dose steroids other treatments given within one year of commencing high dose steroids included: orbital irradiation (n=27), orbital decompression (n=20) and eye muscle surgery(n=2).

Visual acuity, clinical activity score, exophthalmos and soft tissue swelling scores showed statistically significant improvement at early follow up (p<0.05). These responses were sustained at 1 year. Diplopia and total movement scores did not show any early or late response.

This study demonstrates that ophthalmological assessment of response to treatment 1 to 2 weeks after high dose steroids is valuable in deciding whether continuation of steroid therapy is likely to lead to long-term benefits. It also suggests that unlike visual acuity and soft tissue features, dysmotility tends to be resistant to steroid therapy even in patients with active disease.