Clinical and immunological changes in patients with severe thyroid associated ophthalmopathy treated with high dose i.v. methylprednisolone pulse therapy followed by oral prednisolone

S. Wengrowicz, M. Puig-Domingo, F. Rodriguez-Alvarez, E. Juarez, J. M. Fabra, E. Guardia, M. Albareda, J. Soldevila, J. R. Wall, A. De Leiva

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Abstract

High doses of oral steroids has been widely used to manage thyroid- associated ophthalmopathy (TAO), but limited by poor tolerance or effectiveness. The aim of this study was to investigate the effects of intravenous pulses of methylprednisolone (i.v. MP) followed by oral prednisolone in patients with active and severe TAO. Design and Methods: Ten patients were selected for treatment in an open study. Ophthalmological assessment and orbital magnetic resonance imaging (MRI) was performed to determine disease activity, severity and outcome of immunosuppression. Patient sera was tested for detection of antibodies (Ab) reactive with pig eye muscle membrane (PEMM) proteins in immunoblotting. Results: Clinical activity score (ranged 0-7) fell significantly in all patients within the first week of treatment from (mean ± SD) 5.6 ± 0.84 to 2.6 ± 0.84 (p < 0.01) and remained stable 12-36 months later. This was accompanied by a reduction in proptosis, upper lid retraction and lagophthalmos with healing of keratitis. Intraocular pressure was normalized and extraocular muscle shrinkage could be observed in MRI. Two patients required additional optic nerve decompression. Titers of antibodies against PEMM proteins decreased significantly but remained detectable during follow up. Pretibial myxedema disappeared in a patient in whom hyperthyroidism relapsed by the end of treatment. Side effects were minimal and transient. Conclusions: Treatment with i.v. MP pulses followed by oral prednisolone is effective, safe and well tolerated for control of the TAO. It has to be determined if changes in PEMM Ab titers influence prognosis and if they could be useful for prediction of TAO relapses.
Original languageEnglish
Pages (from-to)117-122
JournalEndocrinologia y Nutricion
Volume46
Issue number4
Publication statusPublished - 13 Dec 1999

Keywords

  • Eye-muscle antibodies
  • Graves-Basedow' disease
  • Methylprednisolone
  • Thyroid-associated ophthalmopathy

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