Bilge Batu Oto, Department of Ophthalmology, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Istanbul, Turkey e-mail: batubilge@gmail.com                                 

Clinical Results of Combined Systemic Steroid and Retroorbital Radiotherapy Treatment in Active Thyroid Associated Ophthalmopathy

Abstract

Objective: The aim of this study is to evaluate the efficacy of a different steroid dosage protocol which consists of intravenous pulse methylprednisolone combined with retroorbital radiotherapy in the treatment of active thyroid associated ophthalmopathy.

Methods: The medical records of 29 patients who were treated with a standard protocol and who were followed-up for at least 6 months were retrospectively analyzed. The treatment protocol consisted of intravenous pulse methylprednisolone 1gram/day for 3 consecutive days, followed by retroorbital radiotherapy. Oral prednisolone which was tapered over a 3-month course was given as a maintenance dose.

Results: 58 eyes of 29 patients were included in the study. Twelve patients were female (41%) and 17 were male (59%) with a mean age of 47.7 ± 12.6 years. The clinical activity score was 4.8 ± 1.3 and 2.8 ± 1.2, before and after treatment, respectively (P <0.05). 14 eyes (31%) had an improvement in best corrected visual acuity. In 28 eyes with had proptosis, proptosis regressed after treatment. Among 21 patients with diplopia, 13 (61%) patients reported an improvement in diplopia after treatment (P <0.05). None of our patients had any adverse event due to systemic steroid and retroorbital radiotherapy.

Conclusions: Pulse intravenously applied methylprednisolone for 3 days as 1 gram/day, combined with retroorbital radiotherapy proved to be effective in control of moderate to severe and active thyroid associated ophthalmopathy. In the 6-month follow-up significant decrease in clinical activity score and improvement in diplopia was observed in addition to improvement in best corrected visual acuity.

Keywords: Orbital radiotherapy; Thyroid ophthalmopathy; Graves’ disease

Aktif Tiroid Orbitopatide Kombine Sistemik Steroid ve Retroorbital Radyoterapi Tedavisinin Klinik Sonuçları

Öz

Amaç: Bu çalışmanın amacı, aktif tiroid orbitopati tedavisinde retroorbital radyoterapi ile kombine intravenöz pulse metilprednizolondan oluşan farklı bir steroid dozaj protokolünün etkinliğini değerlendirmektir.

Yöntemler: Belirlenmiş standart protokol ile tedavi edilen ve en az 6 ay takip edilen 29 hastanın tıbbi kayıtları retrospektif olarak incelendi. Tedavi protokolü arka arkaya 3 gün 1 gram/gün dozunda intravenöz pulse metilprednizolon ve ardından retroorbital radyoterapiden oluşuyordu. İdame dozu olarak oral prednizolon 3 ay süreyle ayda bir doz azaltılarak verildi.

Bulgular: 29 hastanın 58 gözü çalışmaya dahil edildi. 12 hasta (%41) kadın, 17 hasta (%59) erkekti ve ortalama yaşları 47,7 ± 12,6 idi. Klinik aktivite skoru tedaviden önce ve sonra sırasıyla 4.8 ± 1.3 ve 2.8 ± 1.2 idi (p <0.05). 14 gözde (%31) en iyi düzeltilmiş görme keskinliğinde iyileşme görüldü. Propitozisi bulunan 28 gözde tedavi sonrası propitozis geriledi. Diplopisi olan 21 hastadan 13'ü (%61) tedaviden sonra diplopide iyileşme bildirdi (p <0.05). Hiçbir hastamızda sistemik steroid tedavisine ve retroorbital radyoterapiye bağlı yan etki görülmedi.

Sonuç: Pulse intravenöz 3 gün süreyle 1 gram/gün dozunda uygulanan metilprednizolon, retroorbital radyoterapi ile kombine edildiğinde aktif tiroid orbitopatinin kontrolünde etkili oldu. 6 aylık takipte en iyi düzeltilmiş görme keskinliğinde düzelmenin yanı sıra klinik aktivite skorunda anlamlı azalma ve çift görmede düzelme izlendi.

Anahtar kelimeler: Orbital radyoterapi; tiroid orbitopati; Graves’ hastalığı

Dicle Med J  2023; 50 (2): 149-155

Doi: 10.5798/dicletip.1313177