Journal of Endocrinological Investigation

, Volume 24, Issue 3, pp 152–158

High-dose intravenous corticosteroid therapy for Graves’ ophthalmopathy

  • P. E. Macchia
  • M. Bagattini
  • G. Lupoli
  • M. Vitale
  • G. Vitale
  • G. Fenzi
Original Article
  • 100 Downloads

Abstract

In order to compare oral and high-dose iv corticosteroid therapy for Graves’ disease, 25 patients with Graves’ ophthalmopathy were treated with two weekly iv injections of 1g of methylprednisolone diluted in 250–500 ml of physiological solution for 6 weeks, and were compared to a group of 26 patients treated with oral prednisone at a dose of 60–80 mg/day progressively reduced every 2 weeks for a total duration of 4–6 months. The efficacy of treatment was evaluated using the ophthalmopathy index score. Patients were followed at 3, 6, 12 months, and afterwards yearly. All patients showed a significant improvement in signs and symptoms of orbital inflammation and a slight improvement in proptosis and diplopia. Relevant side-effects were reported from patients receiving oral therapy, but no significant side-effects were observed in patients treated with high iv doses; a few cases presented with gastric pain (highly sensitive to aluminium oxide or ranitidine), while most of the patients referred to cutaneous rashes and a metal taste that disappeared some hours after the infusion. Improvements observed after treatment have been stable in both groups. In conclusion, in addition to a lower incidence of side-effects compared to the classic oral therapy, the high-dose iv steroid therapy provides efficient and stable improvement in Graves’ ophthalmopathy.

Key-words

Graves’ disease autoimmune response/disease corticosteroids intravenous administration and dosage adverse effects thyroid gland/hyperthyroidism 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Werner S., Coleman D.J., Franzen L.A. Ultrasonic evidence of a consistent orbital involvement in Graves’ disease. N. Engl. J. Med. 1974, 28: 1447–1450.CrossRefGoogle Scholar
  2. 2.
    Forbes G., Gorman C.A., Brennan M.D., Gehring D.G., Ilstrup D.M., Earnest F. Ophtalmopathy of Graves’ disease: computerized volume measurement of the orbital fat and muscle. Am. J. Neuroradiol. 1986, 7: 651–656.PubMedGoogle Scholar
  3. 3.
    Perros P., Kendall-Taylor P. Biological activity of autoantibodies from patients with thyroid-associated ophtalmopathy: in vitro effects on porcine extraocular myoblasts. Q. J. Med. 1992, 305: 691–706.CrossRefGoogle Scholar
  4. 4.
    Bahn R.S., Gorman C.A., Woloschak G.E., David C.S., Johnson P.H., Johnson C.M. Human retroocular fibroblast in vitro: a model for the study of Graves’ ophthalmopathy. J. Clin. Endocrinol. Metab. 1987, 65: 665–670.PubMedCrossRefGoogle Scholar
  5. 5.
    Kodama K., Sikorska H., Brandy-Dafoe P., Bayly R., Wall J.R. Demostrating of a circulating autoantibody against a soluble eye muscle antigen in Graves’ ophthalmopathy. Lancet 1982, 2: 1353–1356.PubMedCrossRefGoogle Scholar
  6. 6.
    Salvi M., Miller A., Wall J.R. Human orbital tissue and thyroid membranes express a 64 KDa protein which is recognized by autoantibodies in the serum of patients with thyroid-associated ophthalmopathy. FEBS Lett. 1988, 232: 135–139.PubMedCrossRefGoogle Scholar
  7. 7.
    Feliciello A., Porcellini A., Ciullo I.G.B., Avvedimento E., Fenzi G. Expression of thyrotropin-receptor mRNA in healthy and Graves’ disease retro-orbital tissue. Lancet 1993, 342: 337–338.PubMedCrossRefGoogle Scholar
  8. 8.
    Paschke R., Metcalfe A., Alcalde L., Vassart G., Weetman A., Ludgate M. Presence of nonfunctional thyrotropin receptor variant transcripts in retroocular and other tissues. J. Clin. Endocrinol. Metab. 1994, 79: 1234–1238.PubMedGoogle Scholar
  9. 9.
    Mengistu M., Lukes Y.G., Nagy E.V., Burch H.B., Carr F.E., Lahiri S., Burman K.D. TSH receptor gene expression in retroocular fibroblasts. J. Endocrinol. Invest. 1994, 17: 437–441.PubMedGoogle Scholar
  10. 10.
    Bartalena L., Marcocci C., Chiovato L., Laddaga M., Lepri G., Andreani D., Cavallacci G., Baschieri L., Pinchera A. Orbital cobalt irradiation combined with systemic corticosteroids for Graves’ ophtalmopathy: comparison with systemic corticosteroids alone. J. Clin. Endocrinol. Metab. 1983, 56: 1139–1144.PubMedCrossRefGoogle Scholar
  11. 11.
    Weissel M., Zielinski C., Hauff W., Till P. Combined therapy with cyclosporin A and cortisone in endocrine Basedow endocrine orbitopathy: successful use in compressive optic neuropathy. Acta Med. Austriaca 1993, 20: 9–13.PubMedGoogle Scholar
  12. 12.
    Burch H.B., Wartofsk Y.L. Graves’ ophthalmopathy: current concepts regarding pathogenesis and management. Endocr. Rev. 1993, 14: 747–793.PubMedGoogle Scholar
  13. 13.
    Antonelli A., Saracino A., Alberti B., Canapicchi R., Cartei F., Lepri A., Laddaga M., Baschieri L. High-dose intravenous immunoglobulin treatment in Graves’ ophthalmopathy. Acta Endocrinol. (Copenh.) 1992, 126: 13–23.Google Scholar
  14. 14.
    Bartalena L., Marocci C., Bogazzi F., Bruno-Bossio G., Pinchera A. Glucocorticoid therapy of Graves’ ophthalmopathy. Exp. Clin. Endocrinol. 1991, 97: 320–327.PubMedCrossRefGoogle Scholar
  15. 15.
    Bartalena L., Pinchera A., Marcocci C. Management of Graves’ ophthalmopathy: reality and perspectives. Endocr. Rev. 2000, 21: 168–194.PubMedGoogle Scholar
  16. 16.
    American Thyroid Association Classification of eye changes of Graves’ disease. Thyroid 1992, 2: 235–236.CrossRefGoogle Scholar
  17. 17.
    Grubbs F. Procedures for detecting outlying observations in samples. Technometrics 1969, 11: 1–21.CrossRefGoogle Scholar
  18. 18.
    Grubbs F.E., Beck G. Extension of sample sizes and percentage points for signficance tests of outlying observations. Technometrics 1972, 14: 847–854.CrossRefGoogle Scholar
  19. 19.
    Nagayama Y., Izumi M., Kiriyame T., Yokoyama N., Morita S., Kakezono F., Ohtakara S. Treatment of Graves’ ophthalmopathy with high-dose intravenous methylprednisolone pulse therapy. Acta Endocrinol. (Copenh.) 1987, 116: 513–518.Google Scholar
  20. 20.
    Kendall-Taylor P., Crombie A.L., Stephenson A.M.M.H., Hall K. Intravenous methylprednisolone in the treatment of Graves’ ophthalmopathy. B.M.J. 1988, 297: 1574–1578.CrossRefGoogle Scholar
  21. 21.
    Bromberg N., Romaldini J.H., Sgarbi J.A., Werner R.S., Farah C.S., Figuerido D.I., Laudari H., Werner M.C. Pulse therapy in Graves’ ophthalmopathy: improvement of eye signs and ophtalmic immunoglobulins. In: Gordon A., Gross J., Hennemann G. (Eds.), Progress in thyroid research. A.A. Balkema Publisher, The Hague, 1991, p. 353.Google Scholar
  22. 22.
    Romaldini J.H., Werner R.S., Farah C.S., Figuerido D.I., Tanaka-Matsura L., Bromberg N. Active Graves’ ophthalmopathy (GO) treatment with prolonged methylprednisolone therapy. Thyroid 1993, 3 (Suppl.): T2.Google Scholar
  23. 23.
    Hiromatsu Y., Tanaka K., Sato M., Kuroki T., Nonaka K., Kojima K., Nishimura H., Nishida H., Kaise N. Intravenous methylprednisolone pulse therapy for Graves’ ophthalmopathy. J. Endocr. 1993, 40: 63–72.CrossRefGoogle Scholar
  24. 24.
    Koshiyama H., Koh T., Fujiwara K., Hayakawa K., Shimbo S., Misaki T. Therapy of Graves’ ophthalmopathy with intravenous high-dose steroid followed by orbital irradiation. Thyroid 1994, 4: 409–413.PubMedCrossRefGoogle Scholar
  25. 25.
    Özmen B., Erkin E., Saruç M. The efficacy of high dose pulse steroid (methylprednisolone) therapy in Graves’ ophthalmopathy. Turkish J. Endocrinol. Metab. 1998, 3: 185–189.Google Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2001

Authors and Affiliations

  • P. E. Macchia
    • 1
  • M. Bagattini
    • 1
  • G. Lupoli
    • 1
  • M. Vitale
    • 1
  • G. Vitale
    • 1
  • G. Fenzi
    • 1
  1. 1.Università degli Studi di Napoli “Federico II”NapoliItaly

Personalised recommendations