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THYROID EYE DISEASE
Response to treatment with steroids in patients with thyroid eye disease
BACKGROUND
Graves’ disease is the most common cause of hyperthyroidism (overactive thyroid). Thyroid eye disease (TED) is a condition that occurs in up to 40% of patients with Graves’ disease. TED can include inflammation of the eyes, eye muscles and the surrounding tissues. Symptoms include dry eyes, red eyes, bulging of the eyes and double vision, and can have a significant impact on the quality of life. The severity of the eye disease is often measured in terms of a score called the clinical activity score (CAS). This takes into account the patient’s symptoms and an examination by the physician.
Treatment of TED often includes steroid therapy given by vein into the body (intravenous glucocorticoids) to try to suppress the immune system, which is believed to be the cause of TED. The response to this form of therapy is variable with clinical trials reporting up to 80% response rates, but 20 to 41% of patients do not either respond or experience relapses of TED despite treatment. Newer therapies are now available, therefore identifying factors which can predict a poor response to steroid therapy is increasingly important.
This study aimed to investigate the factors associated with outcomes after intravenous glucocorticoids treatment in a group of patients with moderate-to-severe TED.
THE FULL ARTICLE TITLE
Baczewska N, et al. factors associated with response to intravenous glucocorticoids in active moderate-to-severe thyroid eye disease. Thyroid. 2025;35(4):424-432; doi: 10.1089/thy.2024.0629. PMID 40053436.
SUMMARY OF THE STUDY
This study included patients who have active moderate to severe thyroid eye disease and had a follow-up of at least 6 months. The medical records of 64 patients were analyzed and the data collected included the CAS, smoking status, thyroid function, antibody levels, and other medical problems. Treatment response was evaluated 6 months after intravenous glucocorticoid therapy.
The results showed that TED was diagnosed an average of 1 month after diagnosis of Graves’ disease and intravenous glucocorticoids were started after an average of 4 months after the diagnosis of TED. Study results showed that ~3/4 of patients responded to intravenous glucocorticoid therapy. The patients that responded were significantly younger (50.1 vs 56.6 years) and had a lower CAS. Active smoking and TSH receptor antibody levels were not independently associated with treatment response.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
This study suggests that older age and elevated levels of the CAS before the start of treatment were associated with worse response to intravenous glucocorticoids. This knowledge may help identify patients who may, in this case, use alternative therapies such as immunotherapies for management of their thyroid eye disease.
— Vibhavasu Sharma, MD, FACE
ATA RESOURCES
Graves’ Disease: https://www.thyroid.org/graves-disease/
Hyperthyroidism (Overactive): https://www.thyroid.org/hyperthyroidism/
Thyroid Eye Disease: https://www.thyroid.org/thyroid-eye-disease/
ABBREVIATIONS & DEFINITIONS
Hyperthyroidism: a condition where the thyroid gland is overactive and produces too much thyroid hormone. Hyperthyroidism may be treated with antithyroid meds (Methimazole, Propylthiouracil), radioactive iodine or surgery.
Graves’ disease: the most common cause of hyperthyroidism in the United States. It is caused by antibodies that attack the thyroid and turn it on.
Thyroid eye disease (TED): also known as Graves ophthalmopathy. TED is most often seen in patients with Graves’ disease but also can be seen with Hashimoto’s thyroiditis. TED includes inflammation of the eyes, eye muscles and the surrounding tissues. Symptoms include dry eyes, red eyes, bulging of the eyes and double vision.
Steroids/Glucocorticoids: general anti-inflammatory and immunosuppressive drugs that are commonly used for the treatment of many autoimmune diseases associated with inflammation
CAS: Clinical Activity Score, a scoring system used to evaluate patients with Graves’ ophthalmopathy, and is based on classical signs of inflammation (pain, redness, swelling and function) and that helps predict which patients will benefit from immunosuppressive treatment.
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