Endocrine Abstracts

The European and American Thyroid associations consensus statement from 2022 on the management of Thyroid Eye Disease(TED) was applied in the development of a new clinic. This pathway established a 12-week course of pulsed intravenous-methylprednisolone(IVMP) as first-line treatment for patients with moderate-to-severe active TED. All patients were managed within a multidisciplinary clinic. A retrospective review was conducted of all consecutive patients treated with pulsed IVMP for active TED from March 2023-2025. Data collected included patient demographics, thyroid status at diagnosis, baseline Clinical Activity Score(CAS), rate of treatment completion, adverse events and additional therapies. Forty-six patients(37 females, 9 males, average age 51 years) were treated; median cumulative dose of 4.5g IVMP. At baseline, 81% had Graves’ disease, 11% hypothyroidism, 5% euthyroid and 2% hypothyroid evolving to thyrotoxicosis. At screening, 37% smoked or vaped, 20% were ex-smokers and 43% did not smoke. Thyrotropin receptor antibodies(TRAb) were elevated in 80% and 86% had an orbital MRI. 10% of patients had undergone thyroidectomy or radioactive iodine. Mean pre-treatment CAS was 2.8(range 1–5) improving to 1.5 post IVMP. Diplopia was common(44%). Two patients(4.3%) showed early resolution, discontinuing IVMP. Seven(15.2%) discontinued due to adverse events: deranged liver function(n = 3), mood disturbance(n = 3) and atrial fibrillation requiring ablation(n = 1). Additional therapies included orbital radiotherapy(65%), oral prednisolone(7%), mycophenolate mofetil(4%) and eyelid or muscle surgery(12%). Pulsed IVMP was well tolerated in the majority of patients. Additional treatment modalities were required in a number of patients suggesting the importance of a multimodal approach to patients with active TED.