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.