ECE2014 Poster Presentations Thyroid (non-cancer) (125 abstracts)
Background: Although IV steroids are the treatment of choice for moderate-to-severe graves orbitopathy (M-S GO), the most efficacious regimen is not yet defined. Cases not responding or relapsing after steroid treatment (STx) are not uncommon and STx can cause serious adverse events. The aim of the present study is to define the steroid regimen which balances between efficacy and damage, using stir-sequence orbital-MRI (SsMRIo) as an additional objective tool for the evaluation of activity and severity of GO.
Methods: Forty-seven patients with M-S GO received a cumulative dose of 4.5 g of methylprednisolone in 12 weekly doses. Two weeks post iv-STx, peros-STx (prednisolone for 3 months) was administered to patients with clinical and MRI findings of active disease. CAS and TES scores were measured at baseline, 6, 12 and 24 weeks and SsMRIo was performed at baseline and 12 weeks. Quality of life was evaluated (GO-QoL questionnaire) at baseline, 12 and 24 weeks.
Results: Age was 58.46±13.37 (mean±S.D.), 70.2% were females and 37.8% current smokers. Duration of ocular symptoms was 12.22±13.23 months. Owing to adverse events 10.6%(5/47) discontinued iv-STx. Peros-STX following the IV received 52.4% (22/42) based on the SsMRIo. At the end of the treatment significantly better CAS (CAS at baseline: 6.06±1.17 and at 24 weeks:1.28±1.55, P<0.001) and TES scores (TES at baseline:18.33±6.63 and at 24 weeks: 8.68±7.24, P<0.001) were observed. QoL significantly improved in all domains (Social function at baseline: 3.77±2.79 and at 24 weeks: 7.45±2.98, P=0.000, dependency at baseline: 5.45±3.21, at 24 weeks: 9.05±2.19, P=0.000). Recurrence was comparable in the groups (2/22 and 2/20 patients after having and not having received peros-STx).
Conclusions: Combination of iv-STX and peros-STx is an efficacious and safe regimen for the treatment of GO. SsMRIo can improve the detection of those cases which remain active and need further peros-STx after the iv-STX.