Predictive factors of prognosis after radiation and steroid pulse therapy in thyroid eye disease

Makoto Ito,Yukihiko Oshima,Arisa Takeuchi,Yasuhiro Takahashi,Eisuke Katsuda,Toshie Mori,Kojiro Suzuki,Hirohiko Kakizaki,Yoshimasa Mori,Souichirou Abe

doi:10.1038/s41598-019-38640-5

Makoto Ito, Yukihiko Oshima + Show 8 more

Open Access

https://doi.org/10.1038/s41598-019-38640-5

Copy DOI

Journal: Scientific Reports	Publication Date: Feb 14, 2019
Citations: 15	License type: open-access

Affiliation: Aichi Medical University Hospital

Abstract

To identify predictive factors of prognosis after radiotherapy with concurrent steroid pulse therapy for thyroid eye disease, retrospective analyses were performed among 77 patients. Clinical activity score and magnetic resonance imaging were used to evaluate degrees of orbital inflammation. As a pre-treatment work-up, the thyroid-stimulating antibody (TSAb) level was measured. During a median follow-up of 25.0 months, the 2-year cumulative relapse-free rate (CRFR) was 80.9%. In the univariate analysis, a worse 2-year CRFR was significantly associated with the presence of optic neuropathy (P = 0.001), a higher TSAb rate (P = 0.001), and lower standard deviation (SD) of signal intensity at the extraocular muscle in T2-weighted images (P = 0.006). In the multivariate analysis, TSAb rate and SD affected the CRFR independently. When TSAb activity of 2800% was set as a cut-off at 2 years after treatment, the predictive sensitivity and specificity of relapse were 81.2% and 90.6%, respectively. With regard to SD, the respective sensitivity and specificity values were 81.2% and 82.7% when 100 was set as a cut-off. In conclusion, high TSAb and low SD were significant risk factors for cumulative relapse in orbital radiotherapy. Cut-off values of 2800% for TSAb and 100 for SD may be suitable.

Highlights

Thyroid eye disease (TED) is a periorbital autoimmune disease that disfigures the face and reduces visual function
To maintain a euthyroid state, 66 patients were treated with antithyroid agents, seven with surgery and two with radioactive iodine; at the time of treatment, 13 patients were in a hyperthyroid state and 8 were in a hypothyroid state
The present study is the first report of an association between a higher thyroid-stimulating antibody (TSAb) rate and worse initial response or worse 2-year cumulative relapse-free rate (CRFR) after radiotherapy with steroid pulse therapy

Summary

Introduction

Thyroid eye disease (TED) is a periorbital autoimmune disease that disfigures the face and reduces visual function. The majority of patients with TED do not require intensive treatment[1] because their symptoms remain mild or resolve spontaneously. Combined radiotherapy and steroid pulse therapy is more effective for reduction of TED-related orbital inflammation than either treatment alone, with approximately 80% of cases exhibiting favourable reduced inflammation[1,6,7], though orbital inflammation does sometimes relapse. Understanding predictive factors pertaining to TED prognosis may be helpful with regard to determining the need for frequent follow-up and more aggressive treatment. The relevant factors after radiotherapy and concurrent steroid pulse therapy remain unclear. The aim of the current retrospective study was to investigate predictive factors for TED prognosis after radiotherapy and steroid pulse therapy

Methods

Results

Conclusion