Endocrine Abstracts

Introduction: Glucocorticoids (GCs) are the treatment of choice for moderate-to-severe and active Graves’ orbitopathy (GO), but optimal treatment is still undefined as serious side effects are great concern of GC therapy. The aim of the present study was to evaluate tolerability and safety of two different treatment protocols.

Methods: Consecutive patients were divided according to the protocol of GC therapy into two groups: combined intravenous and oral GC therapy (combined GC group, 66 patients, 49±10 years), and only intravenous GC therapy (IVGC group, 66 patients, 50±11 years, P=NS). Combined GC therapy included 500 mg of methylprednisolone in 500 ml of saline solution for 2 alternative days, followed by oral prednisone tapering dose that was repeated each month for the next 5 months. Cumulative dose was 10.2 g. IVGC therapy included infusions of 500 mg of methylprednisolone for the first 6 weeks, and then infusions of 250 mg for the remaining 6 weeks. Cumulative dose was 4.5 g.

Results: Combined GC therapy induced significantly more side effects in comparison to IVGC (49/66, 74% vs 28/66, 42%, P<0.001), including weight gain of >3 kg (55% vs 22%, P<0.001), hirsutism in female patients (49% vs 4%, P<0.001), myalgias (33% vs 0%, P<0.001), sleeplessness (17% vs 2%, P=0.004), and urinary infections (15% vs 3%, P=0.03). Increase in total cholesterol (42% vs 35%) and development of diabetes (8% vs 3%) was also more prevalent without reaching statistical significance (P=NS). Considering serious side effects two patients in combined GC group developed herpes zoster infection and pulmonary tuberculosis, whereas one patient in IVGC group had myocardial infarction during IVGC therapy.

Conclusion: Side effects were more prevalent in the combined group, as a consequence of higher cumulative dose, longer duration of therapy (6 months vs 3 months), and treatment schedule. Careful monitoring during GC therapy in patients with GO is mandatory in both treatment protocols.