Endocrine Abstracts

We have retrospectively studied the clinical outcome of 58 patients (14 men and 44 women) with autoimmune thyroid disease and active GO, treated with high dose intravenous methylprednisolone (MP; cumulative dose 7.5 g). Ophthalmological assessment was performed at baseline and at 6, 12 and 24–30 weeks after the first MP infusion. In 43/58 patients we have also studied NR3C1gene polymorphism, which has been associated to different sensitivity to steroids. The therapeutic outcome has been assessed as: i) reduction of clinical activity score (CAS) ≥2 point or ii) of proptosis ≥2 mm or iii) improvement of diplopia according to the Gorman score, in relation to age, gender, duration of thyroid or orbital disease, smoking habits, serum parameters (TRAb, TSH, FT₃, F₄ concentrations) and genetic data (NR3C1gene polymorphisms). A significant clinical improvement was observed in 67% of patients at 6 weeks and in 80% at 12 weeks; this rate decreased to 70% at 24 weeks as a consequence of relapse of GO in 8 patients (13%). At 12, but not at 6 and 24 weeks, the reduction of the CAS, observed in 80% of patients, was more evident in non-smoking patients (62.5%) than in smokers (37.5%; χ²; P<0.045). A decrease of proptosis ≥2 mm was also significantly associated with the reduction of CAS ≥2 in 34.3% of the patients, who at 12 weeks had a significant response to treatment (χ²; P<0.003). No significant changes in the Gorman score were observed after treatment. No association was found between the therapeutic response to MP and clinical, serological and genetic parameters. Our data show that: i) the therapeutic response of MP is observed in as many as 70% of patients; ii) treatment may be more responsive in non-smoking patients and iii) proptosis reduction is the ophthalmological parameter better associated to inactivation of GO after MP.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.