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The role of intravenous methylprednisolone immunosuppression in the management of active thyroid eye disease.
MedLine Citation:
PMID:  20812826     Owner:  NLM     Status:  In-Process    
PURPOSE: To analyze the efficacy of intravenous methylprednisolone (IVMP) immunosuppression in the management of active thyroid eye disease (TED).
METHODS: This is a consecutive case series of 36 patients treated with 1 g of IVMP over 3 days, between January 2000 and January 2008. The indications for this treatment were moderate to severe active TED with or without optic nerve compression.
RESULTS: There were 32 hyperthyroid, 2 hypothyroid, and 2 euthyroid patients in this series. Nine patients presented with optic nerve compromise, 3 had severe active TED and 24 had moderately active TED. Twenty-seven patients received one course of IVMP and nine patients received two courses. All patients had tapering oral prednisolone over 1 month following the IVMP. The mean improvement in proptosis was 1.31 mm (range = 0-3 mm). Optic nerve function improved in seven of nine patients (77.8%). Extra ocular muscle movement improved in 18 patients (50%). Overall benefit from IVMP was seen at 1/12 in 27 patients (75%) and at 3/12 in 30 patients (83%). After IVMP one patient underwent radiotherapy and three patients had nonsteroidal immunosuppression.
CONCLUSIONS:  IVMP immunosuppression is effective in 83% of patients. The effect lasts from 3 months to 8 years, with a mean of 15 months in 30.5%. It remains a useful modality of treatment especially when the optic nerve or cornea is threatened because of moderate to severe active TED. We encountered no severe side effects of pulsed IVMP and 3 g over 3 days is a safe dose.
Katya Tambe; Jonathan Bhargava; Ajay Tripathi; Marelena Gregory; Joyce Burns; Raghavan Sampath
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Publication Detail:
Type:  Journal Article     Date:  2010-09-02
Journal Detail:
Title:  Orbit (Amsterdam, Netherlands)     Volume:  29     ISSN:  1744-5108     ISO Abbreviation:  Orbit     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301221     Medline TA:  Orbit     Country:  England    
Other Details:
Languages:  eng     Pagination:  227-31     Citation Subset:  IM    
Lid, Lacrimal and Orbit Service, Department of Ophthalmology, Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester LE1 5WW, UK.
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