Treatment of Graves' ophthalmopathy with oral or intravenous corticosteroids

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Oral or intravenous corticosteroids are the first choice of clinicians in medical treatment of Graves' ophthalmopathy. Most clinicians use high-dose intravenous corticosteroid pulse therapy only in cases of severe ophthalmopathy. However, there are reports about smaller side effects of intravenous steroids in comparison to oral therapy. Therefore, clinicians have the problem to choose the optimal therapy (oral vs. intravenous), duration of treatment and doses of corticosteroids. Randomized, controlled studies comparing oral versus intravenous corticosteroids in the therapy of Graves' ophthalmopathy were selected. Both forms of application are able to reduce the clinical symptoms of Graves' ophthalmopathy. Therefore, oral and intravenous corticosteroid therapies are evidence-based. Most studies used uniform drug regimen protocols for oral application of corticosteroids with initial dosages of 60-100 mg (7-14 days) and dose reduction over several months. Drug regimen protocols for intravenous application were more different with initial dosages of 500-1,000 mg methylprednisolone at distinct intervals. Corticosteroid doses in the studies varied between 1-21 g. The beneficial therapeutic effect on clinical activity of Graves' ophthalmopathy was pronounced in the intravenous corticosteroid application form in two studies. Oral and intravenous forms of corticosteroid therapy are appropriate to reduce clinical symptoms of Graves' ophthalmopathy. However, most of the published studies are not eligible to compare effectiveness and side effects of both therapy regimens and to identify the most appropriate method.