Hormones (Athens, Greece) · 2025
Predictive factors for surgical interventions following intravenous glucocorticoid pulse therapy in active moderate-to-severe thyroid eye disease.
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Giannakogeorgou Anna, Spira Dominik, Maurer Lukas, Haberbosch Linus, Mai Knut, Salchow Daniel J, Bobbert Thomas
Аннотация
PURPOSE: Thyroid eye disease (TED) is the most common extrathyroidal manifestation of Graves' disease (GD), driven by stimulatory thyrotropin receptor autoantibodies (TRAbs). Intravenous glucocorticoid pulse therapy (ivGC) is the first-line treatment for active moderate-to-severe TED. This retrospective cohort study aimed to identify predictive factors associated with treatment response in TED patients receiving ivGC therapy.
METHODS: We analyzed data from 146 TED patients treated with ivGC at our endocrine outpatient center between 2014 and 2021. The median treatment duration was 11 weeks (IQR: 1), with a median cumulative dose of 4.25 g (IQR: 0.25). The primary outcome was defined as the absence of the need for additional orbital decompression or strabismus surgery. Secondary outcomes included changes in ophthalmological and thyroid-related parameters. Predictive factors were identified using binary logistic regression.
RESULTS: The primary outcome was achieved in 20.54% of the patients. Predictors of surgery following ivGC treatment included current smoking (OR = 4.854, 95% CI: 1.522-15.482), age (OR = 1.051, 95% CI: 1.002-1.101), baseline diplopia (OR = 4.987, 95% CI: 1.218-20.417), and impaired visual acuity (OR = 0.274, 95% CI: 0.078-0.965). IvGC treatment improved diplopia (risk ratio = 0.87), and clinical activity score (Cohen's d = 1.30), with a trend toward reduced TRAb levels (Cohen's d = 0.71).
CONCLUSION: Smoking, diplopia, and age were unfavorable for avoiding surgery, while impaired visual acuity was favorable. IvGC was associated with significant ophthalmological improvements. These findings support more personalized approaches to TED treatment.
METHODS: We analyzed data from 146 TED patients treated with ivGC at our endocrine outpatient center between 2014 and 2021. The median treatment duration was 11 weeks (IQR: 1), with a median cumulative dose of 4.25 g (IQR: 0.25). The primary outcome was defined as the absence of the need for additional orbital decompression or strabismus surgery. Secondary outcomes included changes in ophthalmological and thyroid-related parameters. Predictive factors were identified using binary logistic regression.
RESULTS: The primary outcome was achieved in 20.54% of the patients. Predictors of surgery following ivGC treatment included current smoking (OR = 4.854, 95% CI: 1.522-15.482), age (OR = 1.051, 95% CI: 1.002-1.101), baseline diplopia (OR = 4.987, 95% CI: 1.218-20.417), and impaired visual acuity (OR = 0.274, 95% CI: 0.078-0.965). IvGC treatment improved diplopia (risk ratio = 0.87), and clinical activity score (Cohen's d = 1.30), with a trend toward reduced TRAb levels (Cohen's d = 0.71).
CONCLUSION: Smoking, diplopia, and age were unfavorable for avoiding surgery, while impaired visual acuity was favorable. IvGC was associated with significant ophthalmological improvements. These findings support more personalized approaches to TED treatment.