Original Articles
Effect of steroid pulse therapy with and without orbital radiotherapy on Graves’ ophthalmopathy

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Abstract

Purpose

To report the effect of high-dose intravenous corticosteroid pulse therapy with and without orbital radiotherapy on Graves’ ophthalmopathy.

Design

Nonrandomized clinical trial.

Methods

We selected 39 Japanese patients (age range, 22–64 years; mean, 48 years; 31 women, 8 men) who had active Graves’ ophthalmopathy among 195 consecutive patients. In the first 20 patients, high-dose intravenous methylprednisolone pulse therapy (1 g per day for 3 successive days, repeated 3 times within 3 weeks) followed by 24-Gy orbital radiotherapy was performed. In the other 19 of the 39 patients, high-dose intravenous methylprednisolone pulse therapy without orbital radiotherapy was performed. Coronal computed tomography (CT) of the orbit and exophthalmometry were performed before the corticosteroid pulse therapy, and 1 and 6 months after the corticosteroid pulse therapy. The maximum coronal section area of the most hypertrophic rectus muscle in each eye was measured based on orbital CT imaging.

Results

Clinical findings at study entry were not significantly different between the two groups. No significant difference was found in the maximum coronal section area of the most hypertrophic rectus muscle and the results of exophthalmometry measurements in both groups before the therapy. Extraocular muscle hypertrophy was significantly reduced 1 month and 6 months after the therapy (P < .01) in both groups. However, no beneficial therapeutic effect on proptosis was observed in either group at 1 month and 6 months after the therapy. No significant difference in the therapeutic effect on extraocular muscle hypertrophy and proptosis was found between the two groups.

Conclusions

Orbital irradiation after corticosteroid pulse therapy had no beneficial therapeutic effects on rectus muscle hypertrophy or proptosis of active Graves’ ophthalmopathy during the 6-month follow-up period.

Section snippets

Experimental design

A nonrandomized clinical trial was designed to investigate the effect of high-dose intravenous corticosteroid pulse therapy with and without orbital radiotherapy on Graves’ ophthalmopathy.

Participants and inclusion criteria

The diagnosis of Graves’ disease was based on history; the presence of conventional symptoms of thyrotoxicosis associated with a diffusely enlarged goiter; elevated levels of serum T3, free T3, T4, and free T4; and increased thyroidal 131I uptake. Elevated titers of antithyroid-stimulating antibody,

Results

There was no significant difference in the maximum coronal section area of the rectus muscle and the results of exophthalmometry between the two groups at study entry (FIGURE 2, FIGURE 3) (two-tailed t test).

Extraocular muscle hypertrophy improved immediately after the therapy in both groups. Figure 4 shows changes in the maximum coronal section area of the rectus muscle in both groups before and 1 month and 6 months after the therapy. In the pulse group, the mean values of the maximum coronal

Discussion

All significant clinical findings in the early stage of active Graves’ ophthalmopathy can be traced back to inflammatory edema of the extraocular muscle and the retrobulbar connective tissue.20, 21, 22, 23 Inflammatory edema causes extraocular muscle hypertrophy and proptosis. In the chronic stage, proliferation of fibroblasts and accumulation of glycosaminoglycans were noted in addition to inflammatory edema.20, 21, 22, 23 These chronic changes cause restriction of extraocular muscle motion

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