Endocrine Abstracts

Thyroid eye disease is the most frequent extrathyroidal manifestation of Graves’ disease. Severe and active disease is frequently treated with immunosuppressive therapy. IV methylprednisolone (500 mg daily for 3 days) is the treatment of choice with efficacy rates of up to 77%. New onset glucose intolerance/diabetes is the most relevant side effect of this treatment. We investigated the risk of steroid induced diabetes and the risk factors for its development.

Aims: To quantify the risk of developing impaired glucose tolerance/diabetes as a consequence of IV methyl prednisolone therapy.

To look at factors predisposing to an increased risk of developing diabetes.

Methods: Retrospective analysis of case notes of patients attending Thyroid eye clinic (1998–2007).

Pathology reports used to inform glucose values checked before treatment commencement and after each dose.

Definitions: Impaired glucose tolerance (IGT): >7.8 mmol/l: <11.1 mmol/l.

Diabetes mellitus: >11.1 mmol/l.

Results: Eighty-seven courses of treatment with IV methyl predisolone were received by forty-five patients of whom twenty-four patients (51.1%) had abnormal glucose values. Fourteen patients (31.1%) had values >11.1 mmol/l and 10 patients (22.2%) had values >7.8 but <11.1 mmol/l. Of the thirty-three patients with no family history or prior diagnosis of diabetes, 16 patients showed glucose intolerance with 9 patients (27.2%) showing IGT (>7.8–<11.1 mmol/l) and 7 patients (21.2%) demonstrating diabetes (>11.1 mmol/l).

A family history of diabetes in a first-degree relative was identified in seven patients of which three patients (42.8%) developed diabetes during treatment. Four patients already had type 2 diabetes and one patient had type 1 diabetes.

Conclusions: The risk of developing diabetes with Methylprednisolone in a patient cohort with no family history of diabetes is 21.2%. A positive family history of diabetes increases this risk to 42.8% and so this subgroup merits careful follow up during treatment.