Clinical Results of Combined Systemic Steroid and Retroorbital Radiotherapy Treatment in Active Thyroid Associated Ophthalmopathy

Abstract

Objective: The aim of this study is to evaluate the efficacy of a different steroid dosage protocol which consists of intravenous pulse methylprednisolone combined with retroorbital radiotherapy in the treatment of active thyroid associated ophthalmopathy. Methods: The medical records of 29 patients who were treated with a standard protocol and who were followed-up for at least 6 months were retrospectively analyzed. The treatment protocol consisted of intravenous pulse methylprednisolone 1gram/day for 3 consecutive days, followed by retroorbital radiotherapy. Oral prednisolone which was tapered over a 3-month course was given as a maintenance dose. Results: 58 eyes of 29 patients were included in the study. Twelve patients were female (41%) and 17 were male (59%) with a mean age of 47.7 ± 12.6 years. The clinical activity score was 4.8 ± 1.3 and 2.8 ± 1.2, before and after treatment, respectively (P <0.05). 14 eyes (31%) had an improvement in best corrected visual acuity. In 28 eyes with had proptosis, proptosis regressed after treatment. Among 21 patients with diplopia, 13 (61%) patients reported an improvement in diplopia after treatment (P <0.05). None of our patients had any adverse event due to systemic steroid and retroorbital radiotherapy. Conclusions: Pulse intravenously applied methylprednisolone for 3 days as 1 gram/day, combined with retroorbital radiotherapy proved to be effective in control of moderate to severe and active thyroid associated ophthalmopathy. In the 6-month follow-up significant decrease in clinical activity score and improvement in diplopia was observed in addition to improvement in best corrected visual acuity.

Keywords

• Orbital radiotherapy
• Thyroid ophthalmopathy
• Graves’ disease

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