High-Dose Intravenous Steroid Pulse Therapy in Thyroid-Associated Ophthalmopathy
Department of Medicine and Clinical Science, Kyoto University, Kioto, Kyōto, JapanEndocrine Journal (Impact Factor: 2). 01/1997; 43(6):689-99. DOI: 10.1507/endocrj.43.689
To evaluate the efficacy of high-dose intravenous steroid pulse followed by oral steroids in the treatment of thyroid-associated ophthalmopathy, we performed clinical assessment and measurement of retroorbital muscle enlargement in 27 patients before and after the therapy, and followed them up longitudinally. The mean duration of follow up is (mean +/- SD) 29.8 +/- 23.8 months (range 4-92). Diplopia disappeared in 10 patients and ameliorated in 11 patients. The degree of proptosis decreased in 15 patients and the fall in visual acuity improved in a third of the patients. The total ophthalmopathy index (OI) decreased from 7.0 +/- 1.9 to 3.0 +/- 1.5. The extraocular muscle enlargement (EME), expressed as the maximal ratio of extraocular muscle thickness to the diameter of the optic nerve, decreased from 2.33 +/- 0.56 to 1.27 +/- 0.26. No major side effects were found in any patient. The improvement in the eye disease was found immediately after the pulse therapy, prior to the start of the following therapy by oral steroids and/or orbital irradiation. Both of OI and EME decreased with time after the therapy and did not get worse after withdrawing oral steroids. The efficacy of the therapy evaluated by degrees of improvement in OI and in EME was significantly greater in females than in males. Although there was a significant positive correlation between initial OI and EME values and initial TBII and TSAb activities, a significant correlation was seen only between the degrees of improvement in EME and changes in TBII activity due to the therapy. The duration of eye disease, thyroid status, treatment with anti-thyroid drug, smoking and experience of previous treatment did not affect the efficacy of the present therapy. We conclude that high-dose intravenous steroid pulse therapy is effective and safe for thyroid-associated ophthalmopathy.
Article: Endokrine Orbitopathie 1998[Show abstract] [Hide abstract]
ABSTRACT: □ HintergrundDie häufigste extrathyreoidale Manifestation der autoimmunen Thyreopathie ist die endokrine Orbitopathie. □ Klinisches BildDas Charakteristikum dieser Autoimmunerkrankung ist die entzündliche Volumenzunahme des peri- und retrobulbären Gewebes, die zur klinischen Symptomatik nichtinfiltrativer Lidaffektionen, Protrusio bulbi, Augenmuskelparesen und bis hin zum Visusverlust führen kann. Die pathologischen Veränderungen der endokrinen Orbitopathie sind gekennzeichnet durch immunologisch vermittelte Entzündungsreaktionen im Retrobulbärraum, in deren Verlaufes zur lymphozytären Infiltration und Einlagerung von Glykosaminoglykanen in das orbitale Muskel-, Binde- und Fettgewebe kommt. □ Diagnose und TherapieTrotz verschiedener neuer diagnostischer Möglichkeiten und therapeutischer Ansätze bietet das adäquate Vorgehen bei der enkokrinen Orbitopathie häufig Schwierigkeiten, vor allem bei rezidivierenden und schweren Verläufen. Mit neuen Erkenntnissen in der Pathogenese und weiteren klinischen Studien sind neue diagnostische und therapeutische Ansätze bei der Behandlung der endokrinen Orbitopathie entstanden. □ SchlußfolgerungEine interdisziplinäre Zusammenarbeit ist für eine effiziente Diagnostik, adäquate Therapie und eine kontinuierliche Nachsorge bei der endokrinen Orbitopathie von entscheidender Bedeutung. □ BackgroundOphthalmopathy is the most common extrathyroidal manifestation of Graves’ disease, also called thyroid-associated ophthalmopathy. □ ClinicsThis autoimmune disorder is characterized by a lymphocyte infiltration of the retrobulbar space. Activated T cells react with the target organ and secrete cytokines, leading to accumulation of glycosaminoglycans, interstitial edema of the peri- and retrobulbar tissue and enlargement of the extraocular muscles. During the inflammatory stage, the increased orbital pressure results in the clinical manifestation of the eye disease. □ Diagnosis and TreatmentThus, therapeutic immunosuppression is often used initially, and by suppressing inflammatory changes, it can result in subjective and objective improvement of the thyroid eye disease. In recent years, new pathogenetic aspects and clinical randomized trials led to modified therapy concepts. □ ConclusionInterdisciplinary management is recommended for rapid diagnosis and effective therapy of patients with thyroid-associated ophthalmopathy.Medizinische Klinik - Intensivmedizin und Notfallmedizin 06/1998; 93(6):365-373. DOI:10.1007/BF03044681 · 0.56 Impact Factor
Article: [Endocrine orbitopathy 1998].[Show abstract] [Hide abstract]
ABSTRACT: Ophthalmopathy is the most common extrathyroidal manifestation of Graves' disease, also called thyroid-associated ophthalmopathy. CLINICS: This autoimmune disorder is characterized by a lymphocyte infiltration of the retrobulbar space. Activated T cells react with the target organ and secrete cytokines, leading to accumulation of glycosaminoglycans, interstitial edema of the peri- and retrobulbar tissue and enlargement of the extraocular muscles. During the inflammatory stage, the increased orbital pressure results in the clinical manifestation of the eye disease. Thus, therapeutic immunosuppression is often used initially, and by suppressing inflammatory changes, it can result in subjective and objective improvement of the thyroid eye disease. In recent years, new pathogenetic aspects and clinical randomized trials led to modified therapy concepts. Interdisciplinary management is recommended for rapid diagnosis and effective therapy of patients with thyroid-associated ophthalmopathy.Medizinische Klinik 07/1998; 93(6):365-73. · 0.27 Impact Factor
Article: Pulse glucocorticoids[Show abstract] [Hide abstract]
ABSTRACT: High-dose intravenous (i.v.) methylprednisolone has been used therapeutically in a number of medical fields to avoid the complications and side effects of long-term glucocorticoid (GC) therapy and because of the perception that high-dose i.v. methylprednisolone may have "special" therapeutic effects. It is possible that aggressive early therapy with GCs allows for a more rapid taper of GCs and therefore prevents some of the dose-related side effects associated with long-term use. Some of the neurologic and rheumatologic literature related to multiple sclerosis and lupus nephritis suggest that i.v. methylprednisolone has therapeutic effects that are different from those of conventional doses of oral prednisone. There is still considerable debate about this in nondermatologic fields, and extrapolation of the role of pulse i.v. methylprednisolone to dermatologic disease, where trials are lacking, is difficult. Given this subset of possible candidates of this therapy as suggested by anecdotal reports, there is at least a rationale for considering the use of this modality in a subset of patients.Dermatologic Clinics 08/2000; 18(3):437-46, viii-ix. DOI:10.1016/S0733-8635(05)70192-3 · 1.69 Impact Factor
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