Predictive factors of the response to intravenous glucocorticoids for active moderate-to-severe thyroid eye disease

MD Natalia Baczewska,; MD Maria-Cristina Burlacu,

doi:10.1530/endoabs.106.003

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Endocrine Abstracts (2024) 106 003 | DOI: 10.1530/endoabs.106.003

BES2024 BES 2024 CLINICAL STUDIES (17 abstracts)

Predictive factors of the response to intravenous glucocorticoids for active moderate-to-severe thyroid eye disease

Natalia Baczewska, MD¹ & Maria-Cristina Burlacu, MD¹

Author affiliations

¹Department of Endocrinology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Please send all correspondence to: N. Baczewska, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium, tel: +32 764 18 12, email: [email protected] Conflict of interest: The authors have nothing to disclose and indicate no potential conflict of interest

Objectives: To determine the predictive factors associated to the response to intravenous glucocorticoids (IVGC) administered in patients with active moderate-to-severe thyroid eye disease (TED).

Methods : We retrospectively studied 65 patients with active moderate-to-severe TED, with or without optic neuropathy (DON) treated between 2003 and 2023 at Cliniques Universitaires Saint-Luc in Brussels. The patients were treated either with three-days IVGC pulse therapy or 12 weeks IVGC EUGOGO (European Group on Graves Orbitopathy) schema. The response was evaluated at the end of the treatment with the revised EUGOGO 2021 composite index.

Results: Out of the 65 patients, 43 (66.2%) were responders. Responders were younger than non-responders at the start of treatment (51.49 ± 12.80 vs. 57.23 ± 12.82 years, P = 0.092) and had a female predominance (79.1% vs. 20.9%, P = 0.089). Non-responders had higher pre-IVGC triglyceride levels (145 ± [85178.75] vs. 106 ± [75.75-133.25] mg/dl, P = 0.042) without significant differences in statin use. There were no significant differences in smoking status, thyroid function and TSH receptor antibodies levels before IVCG between responders and non-responders. A pre-treatment CAS (clinical activity score) > 4 and DON were more frequently observed in non-responders (81.8% vs. 27.9%, P = 0.002 and 68.2% vs. 27.9%, P = 0.008 respectively). A post-treatment CAS ≥ 3 was present in 77.2% of non-responders compared to 2.3% of responders ( P < 0.05). Non-responders more frequently required second-line treatments (36.4% vs. 7%, P = 0.003) and underwent active phase orbital decompression (59.1% vs. 9.3%, P < 0.05). Among the 49 patients treated according to the EUGOGO regimen, 35 (71.4%) were responders. DON, a pre-treatment CAS > 4 and a post-treatment CAS ≥ 3 were more frequent in non-responders (50% vs. 11.4%, P = 0.014; 78.6% vs. 28.6%, P = 0.006 and 78.6% vs. no patient, P < 0.05 respectively). A posttreatment CAS ≥ 3 was present in 78.6% of non-responders compared to 0% of responders ( P < 0.05).