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Medium-dose intravenous methylprednisolone pulse therapy for thyroid-associated orbitopathy
Ashfaque Rahman Khan1, Sadia Sultana2, Riffat Rashid2
1Bangladesh Eye Hospital, Zigatola Ltd., Dhaka 1209, Bangladesh.
International Journal of Ophthalmology
|July 29, 2026
Summary
Medium-dose intravenous methylprednisolone (IVMP) effectively treats active thyroid-associated orbitopathy (TAO), improving eye symptoms and vision. This safer IVMP regimen is a viable alternative for moderate-to-severe TAO cases.
Area of Science:
- Ophthalmology
- Endocrinology
- Immunology
Background:
- Thyroid-associated orbitopathy (TAO) is an autoimmune condition affecting the eye socket.
- Moderate-to-severe active TAO requires effective treatment to prevent vision loss and improve quality of life.
Purpose of the Study:
- To assess the efficacy and safety of a 4.0 g medium-dose intravenous methylprednisolone (IVMP) pulse regimen for active moderate-to-severe TAO.
- To evaluate changes in clinical activity score (CAS), proptosis, visual acuity, and intraocular pressure (IOP).
Main Methods:
- Prospective interventional study at a tertiary eye care center.
- 30 patients with active TAO (CAS≥3) received 4.0 g IVMP over 5 cycles.
- Outcomes including CAS, proptosis, BCVA, and IOP were measured at baseline and 6 months.
Main Results:
- Significant reduction in mean CAS (3.66 to 0.87) and proptosis (22.47 to 20.13 mm).
- Improvement in best-corrected visual acuity (BCVA) and decrease in intraocular pressure (IOP).
- Over 90% symptom resolution; mild, reversible adverse events like transient increased IOP and hyperglycemia.
Conclusions:
- Medium-dose IVMP (4.0 g) is effective and safe for moderate-to-severe active TAO.
- This regimen offers a safer alternative to high-dose IVMP, especially in resource-limited settings.
- Further multicenter trials with longer follow-up are recommended.
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