The results of treatment of 72 patients with endocrine ophthalmopathy in the Clinical Hospital No. 10 in Minsk during 2 years are presented. Thyroid pathology was detected in 63 patients (87.5%): in 39 (54.2%) - Graves disease, in 24 (33.3%) - autoimmune thyroiditis. All patients with Graves disease received thyrostatic therapy; 10 persons developed ophthalmopathy after thyroidectomy. 11 patients with autoimmune thyroiditis had hypothyroidism and received levothyroxine, the rest had thyrotoxicosis. In 26 patients (36.1%) the process was one-sided. The average age of patients was 34±8 years; (men: women 32:40). The following ophthalmologic examinations were performed: visual acuity test, computer perimetry, CT of the orbits, the study of intraocular pressure. The ophthalmopathy activity assessment was measured according to the CAS scale. Ophthalmic hypertension was detected in 24 patients (33.3%). According to the EUGOGO classification, 68 patients (94.4%) had a moderate severity of the disease, 4 (5.6%) had a severe degree with the development of optic neuropathy and a decrease in visual acuity. Patients with moderate severity received methylprednisolone pulse therapy of 500 mg intravenous No. 3 every other day, in total 3 courses with an interval of 710 days. It was followed by intravenous administration of methylprednisolone 250500 mg once in 710 day No. 6, depending on the activity of the process. The total dosage of methylprednisolone was 8 g, in some cases a prolongation of treatment was required. Due to therapy the signs of ophthalmopathy activity significantly decreased, patients quality of life improved. No significant adverse events including hepatic failure were reported. In 10 cases transient hyperglycemia was observed. Blood pressure increased slightly. The main complaints of patients on the day of administration were hot flashes, heart palpitations, anxiety and insomnia. The patients with severe ophthalmopathy received 750 mg of methylprednisolone intravenous daily for 3 days in a row and then at intervals of one week 500 mg daily for 3 days; in total 2 courses. Subsequent therapy included weekly administrations of 500 mg for 6 weeks. The patients also received nootropic, neurometabolic and diuretic drugs. Improvement in visual acuity was noted after 3 weeks of treatment. By the end of treatment in two patients the visual acuity recovered completely, in others it remained slightly reduced. Therapie complications with large doses of corticosteroids have not been identified. Conclusion: the treatment of endocrine ophthalmopathy using the method of high-dose corticosteroid pulse therapy in form of series of intravenous injections is effective and safe.
18 - 21 May 2019
European Society of Endocrinology