High-dose intravenous corticosteroid therapy for Graves’ ophthalmopathy

In order to compare oral and high-dose iv corticosteroid therapy for Graves’ disease, 25 patients with Graves’ ophthalmopathy were treated with two weekly iv injections of 1g of methylprednisolone diluted in 250–500 ml of physiological solution for 6 weeks, and were compared to a group of 26 patients treated with oral prednisone at a dose of 60–80 mg/day progressively reduced every 2 weeks for a total duration of 4–6 months. The efficacy of treatment was evaluated using the ophthalmopathy index score. Patients were followed at 3, 6, 12 months, and afterwards yearly. All patients showed a significant improvement in signs and symptoms of orbital inflammation and a slight improvement in proptosis and diplopia. Relevant side-effects were reported from patients receiving oral therapy, but no significant side-effects were observed in patients treated with high iv doses; a few cases presented with gastric pain (highly sensitive to aluminium oxide or ranitidine), while most of the patients referred to cutaneous rashes and a metal taste that disappeared some hours after the infusion. Improvements observed after treatment have been stable in both groups. In conclusion, in addition to a lower incidence of side-effects compared to the classic oral therapy, the high-dose iv steroid therapy provides efficient and stable improvement in Graves’ ophthalmopathy.