Outcome of intravenous methylprednisolone in active and severe Graves' orbitopathy: an Asian perspective

Abstract

Outcome of intravenous methylprednisolone in active and severe Graves' orbitopathy: an Asian perspective Purpose: The purpose of this study is to investigate the outcome of the use of intravenous methylprednisolone in patients with active and severe Graves' orbitopathy. Method: A retrospective review was performed on patients requiring intravenous methylprednisolone (IVMP) treatment between January 2012 to September 2016 for Graves' orbitopathy. Electronic patient records at Hong Kong West Cluster including Queen Mary Hospital and Grantham Hospital were reviewed. Results: There were 14 cases requiring IVMP, mean age was 57.8 years old, 35.7% were male and 64.3% were female. Regarding presentation, 92.9% presented with proptosis, 92.9% with ocular dysmotility and 28.6% with eyelid retraction. The average clinical activity score (CAS) was 3.4 out of 7. Dysthyroid optic neuropathy (DON) developed in 35.7% and the average CAS was 3.2. Additional orbital radiotherapy was performed in 57.1% of cases. There was improvement in CAS in 92.9% of cases. However, 1 case did not respond after IVMP and required orbital radiation, repeat IVMP, cyclosporin, Rituximab and bone decompression. Glaucoma treatment was required in 92.9% of cases. Proptosis improved in 42.8% of cases, ophthalmoplegia improved in 28.6% but progressed in 64.3% and stayed the same in 7.1%. 1 patient had deranged liver function tests during IVMP. Conclusion: IVMP is found to be safe and effective in treatment of active and severe Graves' orbitopathy. The CAS score among Asian patients may be relatively lower, even in severe or sight-threatening disease. Glaucoma is a common complication. Residual proptosis and worsening of ophthalmoplegia may occur despite IVMP. Patients on IVMP must be closely monitored for systemic side effects.