[Steroid therapy for Graves' ophthalmopathy]

Area of Science:

• Endocrinology
• Immunology

Context:

• Graves' ophthalmopathy (GO) management often involves glucocorticoids due to their anti-inflammatory and immunosuppressive properties.
• Methylprednisolone intravenous pulse therapy shows a 77% favorable response rate in active, moderately severe GO.
• Glucocorticoid use is advised in low doses and short durations for hyperthyroid Graves' patients undergoing radioiodine therapy to prevent GO progression.

Purpose:

• To review the efficacy and safety of glucocorticoids in managing Graves' ophthalmopathy.
• To highlight recommendations for glucocorticoid use in conjunction with radioiodine therapy.
• To outline significant adverse effects and necessary precautions for intravenous glucocorticoid therapy.

Summary:

• Methylprednisolone iv pulse therapy achieves a 77% favorable response rate for active, moderately severe Graves' ophthalmopathy.
• Low-dose, short-term glucocorticoids are recommended to prevent GO development or progression in hyperthyroid patients receiving radioiodine therapy.
• Major adverse effects include Cushingoid features, glucose intolerance, hypertension, and hepatitis; fatal liver failure occurred in 0.8% of patients receiving high-dose pulse therapy (9-12g).

Impact:

• Establishes the efficacy of glucocorticoids in GO treatment.
• Provides guidance on preventing GO exacerbation during hyperthyroid treatment.
• Emphasizes the critical need for dose limitation (4.5-6g cumulative dose), liver function monitoring, and viral marker assessment to mitigate severe adverse events, including fatal liver failure.