Use of intravenous glucocorticoids for treatment of Graves' orbitopathy

. Graves' ophthalmopathy (GO) also known as thyroid-associated orbitopathy (TAO), is an autoimmune disorder of the retrobulbar tissue, closely linked to autoimmune thyroid disease. Less than 5-10% patients with Graves' disease will develop clinically relevant, active and progressive orbital complications. Treatment of this disease is difficult and often unsatisfactory. Glucocorticoids have been used for treatment of GO because of their anti-inflammatory and immunosuppressive actions during the active phase of GO.Case Report. In June 2013, 57 years old female patient referred to our clinic with complains of: heat intolerance, weight loss, fatigue, tachycardia, high blood pressure - classical picture of thyrotoxicosis. In 2006 subtotal resection of thyroid gland for Grave`s disease was performed. Laboratory studies revealed: TSH-0.01 (N=0.4-4.0µIU/ml); FT4-2.68 (N=0.89-1.76ng/dl); Hematology-leukocytes 4.7 (N=5.2-12.4µL); ESR-14(N=2-15); Thyroid ultrasound showed two nodules in the left lobe: 7X8X11mm, 8X8X8mm. Thyroid scintigraphy with TC-99m excluded hot and cold nodules. Anti-THS-Rec.-2.45 (N=<2.0 LU/L). The patient was given Thiamazole 30mg/day, Propranolol 10mg/day, Prednisolone 15mg/day. After six weeks of treatment the patient’s general condition was significantly improved: FT4-0.96; The dose of Thiamazole was decreased till 10mg/day, Propranolol 5mg/day, Prednisolone withheld. After 4 months the patient attended our clinic with complains of: lacrimation and duality, pain and exophthalmos of left eye. Thyroid function was within normal range. In order to exclude tumor, MRI of the head was performed- the tumor was excluded. Graves' ophthalmopathy was diagnosed. Pulse therapy was begun with Intravenous Methylprednisolone infusion according the following scheme: 1st week 1000mg once a day during 3 days, then 500 mg weekly for 3 weeks and 250 mg weekly for 3 weeks. After that the same infusion once in ten days – (total 4 infusion). Methylprednisolone 4mg 4tab. 3 times a day and Panangin 2tab. two times a day was given per-os. Glucose levels were monitored, it was always normal. After 14 weeks of pulse therapy optimized visual acuity and improvement of soft-tissue inflammatory signs and symptoms were evident.Conclusion. High-dose of i/v steroid therapy provides efficient and stable improvement in Graves' ophthalmopathy