J Korean Ophthalmol Soc.  2019 Jun;60(6):575-581. 10.3341/jkos.2019.60.6.575.

Effect and Prognostic Factors of Systemic Steroid Treatment for Strabismus Associated Thyroid Ophthalmopathy

• Shin GR
• Kim DH

• KMID: 2449711
• DOI: http://doi.org/10.3341/jkos.2019.60.6.575

Abstract

PURPOSE
To investigate the effect of steroid treatment on strabismus associated with thyroid ophthalmopathy.
METHODS
The present retrospective study was conducted on 22 patients diagnosed with strabismus associated with thyroid ophthalmopathy, who were treated with steroids orally or intravenously and followed up for more than one year. Patients were divided into three groups for analysis: an improved group, with no strabismus at the final follow-up visit; a stable group, with no change in the strabismus angle; and a deteriorated group, in which the strabismus angle had worsened. We investigated the characteristics of each group.
RESULTS
In the gender/sex distribution of the 22 patients, 11 of the 15 patients in the improved or stable group were female; six of seven patients in the deteriorated group were male (p = 0.012). Two of the 15 patients in the improved or stable group had a smoking history. However, none smoked after the treatment had started. On the other hand, five of seven patients in the deteriorated group had a smoking history and continued to smoke during and after treatment (p = 0.001). No significant between-group differences were observed with respect to age, diplopia period, strabismus angle, or thyroid function level.
CONCLUSIONS
Treatment with steroids may improve or stabilize strabismus associated with thyroid ophthalmopathy. However, the effect of treatment may differ, depending on whether the patient continues to smoke after treatment is initiated.

Keyword

Steroid treatment; Strabismus; Thyroid ophthalmopathy

MeSH Terms

Diplopia
Female
Follow-Up Studies
Hand
Humans
Male
Retrospective Studies
Smoke
Smoking
Steroids
Strabismus*
Thyroid Gland*
Smoke
Steroids

Reference

References

1. Tagami T, Tanaka K, Sugawa H, et al. High-dose intravenous abdominal pulse therapy in thyroid-associated ophthalmopathy. Endocr J. 1996; 43:689–99.

2. Kauppinen-Mäkelin R, Karma A, Leinonen E, et al. High dose abdominal methylprednisolone pulse therapy venous oral prednisone for thyroid-associated ophthalmopathy. Acta Ophthalmol Scand. 2002; 80:316–21.

3. Kahaly GJ, Pitz S, Hommel G, Dittmar M. Randomized, single blind trial of intravenous versus oral steroid monotherapy in graves' orbitopathy. J Clin Endocrinol Metab. 2005; 90:5234–40.

4. Cockerham KP, Chan SS. Thyroid eye disease. Neurol Clin. 2010; 28:729–55.

5. Dolman PJ, Rath S. Orbital radiotherapy for thyroid eye disease. Curr Opin Ophthalmol. 2012; 23:427–32.

6. Ye X, Bo X, Hu X, et al. Efficacy and safety of mycophenolate abdominal in patients with active moderate-to-severe graves' orbitopathy. Clin Endocrinol (Oxf). 2017; 8:247–55.

7. Prendiville P, Chopra M, Gauderman WJ, Feldon SE. The role of restricted motility in determining outcomes for vertical strabismus surgery in graves' ophthalmology. Ophthalmology. 2000; 107:545–9.

8. Choi KJ, Kim SH, Lee JY. Comparison of patient characteristics in thyroid-associated ophthalmopathy with and without strabismus. J Korean Ophthalmol Soc. 2015; 56:1610–6.

9. Lee YH, Hwang JM, Oh SY. The natural course of strabismus asso-catied with thyroid ophthalmopathy. J Korean Ophthalmol Soc. 2006; 47:1993–8.

10. Woo KI, Kim YD, Lee SY. The clinical characteristics of thyroid orbitopathy in thyroid dysfunction patients in korea. J Korean Ophthalmol. 2008; 49:1387–96.

11. Lim NC, Sundar G, Amrith S, Lee KO. Thyroid eye disease: a southeast Asian experience. Br J Ophthalmol. 2015; 99:512–8.

12. Bertelsen JB, Hegedüs L. Cigarette smoking and the thyroid. Thyroid. 1994; 4:327–31.

13. Bartalena L, Marcocci C, Tanda ML, et al. Cigarette smoking and treatment outcomes in graves ophthalmopathy. Ann Intern Med. 1998; 129:632–5.

14. Eckstein A, Quadbeck B, Mueller G, et al. Impact of smoking on the response to treatment of thyroid associated ophthalmopthy. Br J Ophthalmol. 2003; 87:773–6.

15. Metcalfe RA, Weetman AP. Stimulation of extraocular muscle abdominal by cytokines and hypoxia: possible role in thyroid-associated ophthalmopathy. Clin Endocrinol (Oxf). 1994; 40:67–72.

16. Tan GH, Dutton CM, Bahn RS. Interleukin-1 (IL-1) receptor abdominal and soluble IL-1 receptor inhibit IL-1 induced abdominal production in cultured human orbital fibroblasts from patients with graves' ophthalmopathy. J Clin Endocrinol Metab. 1996; 81:449–52.

17. Hofbauer LC, Mühlberg T, König A, et al. Soluble interleukin-1 abdominal antagonist serum levels in smokers and nonsmokers with graves' ophthalmopathy undergoing orbital radiotherapy. J Clin Endocrinol Metab. 1997; 82:2244–7.

18. Bartalena L, Marcocci C, Pinchera A. Treating severe graves' ophthalmopathy. Baillieres Clin Endocrinol Metab. 1997; 11:521–36.

19. Kendall-Taylor P, Crombie AL, Stephenson AM, et al. Intravenous methylprednisolone in the treatment of graves' ophthalmopathy. BMJ. 1988; 297:1574–8.

20. Ohtsuka K, Sato A, Kawaguchi S, et al. Effect of high-dose abdominal steroid pulse therapy followed by 3-month oral steroid abdominal for graves' ophthalmopathy. Jpn J Ophthalmol. 2002; 46:563–7.

21. Marcocci C, Bartalena L, Tanda ML, et al. Comparison of the abdominaliveness and tolerability of intravenous or oral glucocorticoids associated with orbital radiotherapy in the management of severe graves' ophthalmopathy: results of a prospective, single-blind, randomized study. J Clin Endocrinol Metab. 2001; 86:3562–7.

22. Marcocci C, Marinò M, Rocchi R, et al. Novel aspects of abdominal and radiotherapy management of graves' ophthalmopathy. J Endocrinol Invest. 2004; 27:272–80.

23. Marinó M, Morabito E, Brunetto MR, et al. Acute and severe liver damage associated with intravenous glucocorticoid pulse therapy in patients with graves' ophthalmopathy. Thyroid. 2004; 14:403–6.