Endocrine Abstracts

Introduction: Thyroid-associated ophthalmopathy is the most frequent extrathyroidal manifestation of Graves’ disease. Its treatment is based on the administration of intravenous corticosteroids, and the clinical activity score (CAS), TSH-binding inhibitor immunoglobulin (TBII) and TSH-receptor antibodies (TRAb) have been classically used to measure the response to treatment. However, in recent studies [1] it has been observed that other analytical parameters such as cholesterol and triglycerides could also be related to the response to such treatment.

Methods: A retrospective observational case-control study was performed. We studied 55 patients with thyroid ophthalmopathy who have been admitted to Hospital Clínico Lozano Blesa, in Zaragoza (Spain) in the last 10 years to receive treatment with intravenous infusions of methylprednisolone. From each patient, the previous treatment received for their hyperthyroidism and different variables were taken into account in three key moments: Before the first corticoid infusion, halfway through the treatment (Sixth bolus) and after the twelfth and last bolus. Among these parameters were the CAS (Clinical Activity Score), visual acuity and presence of diplopia, and various analytical parameters (TSH, FT4, cholesterol, LDL, HDL, triglycerides, etc.). The statistical significance has been accepted for values ​​of P < 0.05.

Objectives: To assess whether there is a relationship between the adequate response to intravenous corticosteroid therapy in Graves’ ophthalmopathy and the different analytical parameters previously mentioned.

Results: An increased risk of having poor response to intravenous corticosteroid therapy has been observed in those patients with elevated triglycerides (Odds Ratio (OR) 1.85 [IC95% = 1.05–3.28]), smokers (OR 5.05 [IC 95% = 1.94–27.19]) and in those with high levels of TSH-binding inhibitor immunoglobulin (OR 5.17 [IC 95% = 1.11–24.04]). Moreover, a higher TBII mean (17.4 vs 8.9, P = 0.028) and a higher triglyceride mean (127 vs 81 mg/dl, P = 0.034) were found in nonresponders.

Conclusion: There are several factors that can serve as predictors of response to intravenous corticosteroid treatment in thyroid-associated orbitopathy, some of them are already well known, like antithyroid antibodies or smoking, and others started to gain relevance recently, such as cholesterol or triglycerides. Thus, all these factors could be used to classify Graves’ orbitopathy patients prior to intravenous corticoid treatment and only start that treatment in the group of patients that could potentially have more benefit from it.