Effect of Intravenous Methylprednisolone on the Signs &amp;amp; Symptoms of Graves’ Ophthalmopathy

Muhammad Shah Alam,Shahjada Selim,Syeda Tanzina Kalam,Ajit Kumar Paul,A B M Kamrul-Hasan

doi:10.4236/ojemd.2019.99010

Abstract

Background: Graves’ ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves’ disease (GD). The effect of intravenous methylprednisolone on the signs and symptoms of GO has not been evaluated in the Bangladeshi population. Objective: To observe the effect of intravenous methylprednisolone in active Graves’ ophthalmopathy. Materials/Methods: This prospective study conducted in a tertiary hospital of Bangladesh from May 2009 to November 2010 included 30 patients having moderate to severe ophthalmopathy. In addition to the clinical activity score (CAS), eye involvement was assessed by using the “NOSPECS” scoring system. Results: The mean (±SD) age of the patients was 38.1 ± 10.6 years and male-female ratio was 1.2:1. NOSPECS eye findings before treatment and during the final (3rd) visit of the patients were observed. It was found that lid retraction or lid lag was improved in 21 (70%) of the patients during the final visit. All of the patients had soft tissue swelling initially and all of them improved at the final visit. Bilateral proptosis was present in 19 patients before treatment and improved in 12 (62%) patients during the final visit. Right eye proptosis was present in 9 patients before treatment and improved in 5 (60%) patients during final visit. Extraocular muscle involvement (Diplopia) was present in 15 patients before treatment but improved in 13 (86.0%) patients during the final visit. A significant number of subjects showed significant improvement in all of the NOSPECS eye findings (except unilateral right eye proptosis) during the final visit; all had inactive GO (CAS < 2) at the end of the 3rd visit. Conclusion: Intravenous methylprednisolone appears to be an effective treatment option for active Graves’ ophthalmopathy.

Highlights

Graves’ ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves’ disease (GD) and develops in 25% to 50% of patients
Thirty (30) diagnosed cases of active Graves’ Ophthalmopathy of both sexes aging > 20 years who had not received any specific treatment for GO were enrolled for the study by purposive, convenience nonprobability sampling technique
Clinical activity of GO was assessed by Clinical activity score (CAS) of Graves’ ophthalmopathy; patients with clinical activity score (CAS) > 2 were considered to have active GO [4]

Summary

Introduction

Graves’ ophthalmopathy (GO) is the most frequent extrathyroidal manifestation of Graves’ disease (GD) and develops in 25% to 50% of patients. Patients with serious inflammatory Graves’ ophthalmopathy should be treated with anti-inflammatory drugs and/or radiotherapy to prevent complications like fibrosis, while those with non-inflammatory ophthalmopathy may be treated by surgery immediately [2]. Treatment is based on the severity and activity of GO. The therapeutic approach in patients with moderate-to-severe GO depends on whether the disease is “active” or “inactive”. In patients with the active disease, an immunosuppressive or anti-inflammatory treatment, either systemic therapy and/or RT should be offered. In patients with sight-threatening GO, first-line treatment is based on immunosuppressive or anti-inflammatory therapy but if there is a poor response or the disease is inactive, immediate surgical intervention is warranted. First-line treatment of active moderate to severe GO is systemic glucocorticoids, based on their anti-inflammatory and immunosuppressive effects. The current study was planned to evaluate to the efficacy of intravenous (iv) methylprednisolone (MP) on the signs and symptoms of GO

Study Subjects

Statistical Analysis

Results

Discussions