Endocrine Abstracts

The aim of the study is to estimate the efficacy of intravenous corticosteroid therapy in patients with active, sever Graves’ ophthalmopathy.

Material and methods: 16 patients with bilateral active, sever Graves’ ophthalmopathy were included to the study. Euthyroididsm has been provided, mean dose of methimasol therapy was 9.4±6.6 mg a day, median of TSH- 0.3 mlU/l, median of fT4 –15.3 pmol/l. The median of duration of GO was 6.5 months. All patients were administered methylprednisolone intravenously at a daily dose of 1 g for 3 consecutive days and repeated 3 times for 3 weeks. Disease activity was carried out with Clinical Activity Score (CAS), disease severity – with exophthalometry, visual acuity and presents of diplopia.

Results: Initially the median of CAS was 4 points, the mean proptosis −20.8±4.3 mm, median of visual acuity –0.8. 35.2% of patients had lagophthalm and besides more than half of them had bilateral lagophthalm; 52.9% of subjects had diplopia (more than half of them – in primary gaze).

In 1 month after treatment the median of CAS became 1 point and it has been continuing the same after 6 months of therapy. In 6 months visual acuity was not changed after treatment; the degree of proptosis became no significantly less (mean level 18.8±5.1 mm); the frequency of lagophthalm was decreased to 5.9% (what’s more there were no patients with bilateral lagophthalm already in 1 month after treatment); the frequency of diplopia was significantly decreased to 5.9% to (there were no cases of diplopia in primary gaze already in 1 month after pulse therapy). Thus in 6 months only 1 patient (5.9%) had active process, unilateral lagophthalm, diplopia in extreme gaze and so the course was repeated with positive effect.

Conclusion: Pulse therapy with methylprednisolone can decrease symptoms of activity, frequency of lagophthalm and diplopia.