Curative Effect Study of Intermittent Glucocorticoid Pulse Therapy on Moderate-to-severe Thyroid Associated Ophthalmopathy

LI Tao; YUE Ling

doi:10.13730/j.issn.2097-2148.2023.12.005

Abstract：Objective To explore the effects of intermittent glucocorticoid pulse on moderate-to-severe thyroid-as-sociated ophthalmopathy(TAO)and the influence of clinical characteristics on efficacy.Methods A total of 116 patients with moderate-to-severe TAO who received glucocorticoid pulse therapy in the endocrinology department of author's hos-pital were selected.All patients received 1.5 g methylprednisolone sodium succinate intravenously once a month for 3 months.Clinical activity score(CAS),exophthalmos and lid width were compared before and after treatment.The pa-tients were divided into effective group(n=85)and ineffective group(n=31)according to the efficacy,and the baseline clinical features between the two groups were compared,the factors affecting the efficacy of steroid pulse therapy were explored by Logistic regression analysis.Results The CAS score,exophthalmos and lid width decreased significantly af-ter treatment(all P＜0.001);the overall effective rate was 73.28％.There were no significant differences in age,course of disease,low density lipoprotein cholesterol(LDL-C)free triiodothyronine(FT3),free thyroxine(FT4),thyroid stim-ulating hormone(TSH),thyrotropin receptor antibody(TRAb),exophthalmos and lid width between the two groups(all P＞0.05);compared with effective group the proportion of males and smokers in the ineffective group was higher,while the 25-hydroxyvitamin D and CAS score were lower(all P＜0.05).Logistic regression analysis suggested that smoking,low 25-hydroxyvitamin D level and low CAS score were factors influencing the efficacy of glucocorticoid pulse.Conclusion Intermittent high-dose glucocorticoid pulse therapy is effective in the treatment of TAO;smoking,low 25-hydroxyvitamin D and CAS may increase the risk of ineffective treatment.