Background/Aims: The results for 18 consecutive patients with severe thyroid-associated
ophthalmopathy (TAO) treated with high-dose, pulsed intravenous methylprednisolone (MP)
are presented in this paper.
Methods: Eighteen (18) patients with severe TAO, defined as either optic neuropathy, progressive
diplopia, or severe soft-tissue swelling accompanied by evidence of NOSPECS class
2b or more severe eye disease, were studied in a prospective, noncontrolled case series. Patients
were treated with 1.5 g of intravenous MP, divided over 3 days, followed by a tapering
course of oral prednisolone. All patients were examined before treatment, 1 week and 1 month
after commencement of treatment and at 2–3 monthly intervals thereafter. Assessment of visual
acuity, differential intraocular pressure (IOP), soft-tissue inflammation, diplopia, and exophthalmometry
were used to calculate a modified ophthalmopathy index (OI) for each patient
at each visit. Median duration of follow-up was 14 months.
Results: A statistically significant reduction in OI following treatment with high-dose MP
was observed after 1 week of treatment from 10.8 ± 3.9 standard deviation (SD) to 8.3 ± 3.4
(SD) (P < 0.001) and between 1 week and the end of the treatment period (OI, 7.2 ± 3.4 (SD);
P < 0.05). A response occurred in 83% of patients within a week but only 66% maintained
this response. There was a significant negative correlation between response to treatment (OI
before treatment—OI after treatment) and duration of eye disease (P = 0.034, Spearman correlation).
Conclusions: High-dose, pulsed intravenous MP is an effective medical treatment for severe
TAO. Responders can be identified within the 1st week. Treatment response is inversely
related to disease duration.
