Influence of 4-week or 12-week glucocorticoid treatment on metabolic changes in patients with active moderate-to-severe thyroid-associated ophthalmopathy

Abstract

Thyroid-associated ophthalmopathy (TAO) is a serious, progressive, vision-threatening and difficult-to-treat organ-specific autoimmune disease. The course, therapeutic effects and prognosis of moderate to severe TAO vary greatly. High-dose intravenous glucocorticoid (IVGC) therapy is considered a first-line treatment for active moderate-to-severe TAO, but there is still insufficient evidence regarding the treatment duration. Long-term IVGC therapy can influence the metabolism of glucose, lipids, and bone. This study was designed to compare changes in metabolic and immunological indexes as well as the magnetic resonance imaging apparent diffusion coefficient (ADC) of the extraocular muscles after 4 and 12 weeks of IVGC therapy. Forty-eight patients with active moderate-to-severe TAO were included in this retrospective cohort study. Metabolism and immunological indexes were measured before and after therapy. The ADC and clinical activity score (CAS) were used to evaluate the efficacy of treatment in these patients. We found that the patients in the 12-week group had increased fasting plasma glucose (p = 0.004), glycated hemoglobin (p = 0.028), total cholesterol (p < 0.001), and low-density lipoprotein (p < 0.001) after therapy. The patients in both groups had reduced bone metabolism markers after therapy. Thyroid peroxidase antibody and thyrotropin receptor antibody levels decreased after treatment in both groups (p < 0.001). A significant decrease in thyroglobulin antibody levels was found in the 4-week group (p = 0.006). The change in the ADC was higher in the 4-week group than in the 12-week group (p = 0.014). However, there were no significant differences in CAS values between the two groups. Therefore, 4-week IVGC therapy was recommended for patients with TAO with glucose and lipid disorders.

Figure 1

The patients with active moderate and severe thyroid‐associated ophthalmopathy (TAO) before treatment with symptoms of spontaneous retrobulbar pain, pain on attempted up or down gaze, redness of the eyelids, redness of the conjunctiva, swelling of the eyelids, inflammation of the caruncle and plica, and conjunctival edema

Figure 2

The changes of magnetic resonance imaging after intravenous glucocorticoid (IVGC) treatment in patients with active moderate and severe thyroid‐associated ophthalmopathy. Transversal fat‐saturated T2 weighted (a, b), coronal fat‐saturated T2 weighted (c, d) and apparent diffusion coefficient (e, f) maps in the same plane of orbits in the patient. The measurement of apparent diffusion coefficient values in the superior muscle group (SMG), medial rectus (MR), lateral rectus (LR) and inferior rectus (IR) was made from the thickest part of the muscle in selected coronal planes from both side muscles. The measured area is approximately 10 mm. The red arrows represent LR, the yellow arrows represent MR, the purple arrows represent SMG, the blue arrows represent IR