Endocrine Abstracts

Objectives: The objective of our retrospective cohort study was to identify prognostic factors associated with treatment success in patients with active moderate-to-severe Thyroid Eye Disease (TED) undergoing intravenous glucocorticoid (ivGC) therapy, defined as the absence of the necessity for additional rehabilitative surgery after treatment completion. Additional objectives encompassed evaluating changes in ophthalmological parameters and thyroid-specific markers correlated with TED development and severity by the conclusion of the treatment period. We aimed to optimize disease management strategies by predicting treatment outcomes and identifying potentially responsive individuals.

Methods: At the Department of Endocrinology and Metabolism at Charité – University Hospital of Berlin between 2014 and 2021, 146 patients received standard ivGC pulse therapy as per ATA/EUGOGO guidelines over a 12-week period. Ophthalmological assessments, including visual field examinations, assessments of visual acuity, diplopia, Clinical Activity Score (CAS) and proptosis, were conducted before and after treatment alongside regular blood examinations evaluating thyroid hormone and antibody levels. Appropriate tests were implemented to assess differences in ophthalmological and thyroid parameters before and after treatment, as well as regression models to determine predictive factors associated with treatment outcomes.

Results: Current smoking (Odds Ratio, Or = 3.243, P = 0.010), rather than smoking history, emerged as a significant predictor of the need for additional surgery following ivGC treatment. Similarly, baseline diplopia (Or = 2.971, P = 0.049) was also identified as a significant predictor. Antithyroid drug (ATD) treatment showed marginal significance (Or = 0.388, P = 0.077), indicating a potential predictive role in the requirement for rehabilitative surgery. Following treatment completion, only the CAS and diplopia exhibited statistically significant reductions (P < 0.001 for both), while other ophthalmic parameters did not demonstrate significant changes. Although there was a notable trend towards reduction in Thyrotropin Receptor Antibodies (TRAbs), this change did not reach statistical significance.

Conclusions: Our study underscores the significant opthalmological improvements achieved with ivGC treatment, reflected in the CAS and the reduction of diplopia, a prominent feature impacting the quality of life in Thyroid Eye Disease, which could partially be mediated through reductions, albeit non-significant, in TRAbs. Identifying predictors of treatment efficacy with immunosuppressive therapy, including smoking and baseline diplopia, emphasizes the need for personalized intervention strategies. Moreover, the marginal significance of ATD underscores the importance of maintaining euthyroidism, both to prevent exacerbation and to optimize outcomes during ivGC treatment.