A Single Center Experience of Intravenous Corticosteroid Bolus Doses in Graves’ Ophthalmopathy

Exophthalmos makes up a clinical manifestation very frequent in Graves’ disease. European Group on Graves’ Orbitopathy proposes intravenous glucocorticoids to treat severe, moderate-to-severe and active Graves’ orbitopathy as the first line treatment. The aim of our study is to report results obtained with patients treated for Graves’ ophthalmopathy with this protocol in real life. It is a descriptive and analytical study involving the whole patients with Graves’ ophthalmopathy which activity score ≥3 or who had an optical neuropathy. Evaluated parameters before and after treatment were GO activity score, quality of life and corticosteroid therapy complications. In total, 21 patients received corticoid boluses for Graves’ ophthalmopathy. Sex ratio men/ women was 3.2 with the average age of 37.4±11 years old. Graves’ ophthalmopathy activity score before corticosteroid boluses were 4.5±0.8 with a slight insignificant increase (p=0.58) in smokers (score=4.64) compared with non smokers (4.43). Concerning the seriousness, 8 patients were admitted with severe exophthalmos and 13 showed a moderate-to-severe exophthalmos. Evolution under treatment has been marked by noticeable improvement. Mean activity score was significantly reduced to 1.95±0.74 (p< 0.0001) at the end of 12 boluses and kept at 1.14±0.91 (p< 0.0001) 6 months after the first bolus. Concerning the alteration impact of vision on the quality of life (Q1-8), the score changed from 56±11.5 before boluses to 82.3±11 after boluses (p< 0.0001); furthermore psychosocial impact score raised from 41.9±12 before boluses to 57.4±9.6 after boluses (p< 0.0001). These encouraging results support the use of methylprednisolone bolus in Graves’ ophthalmopathy.