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Purpose

The management of thyroid eye disease (TED) continues to evolve, but intravenous corticosteroids remain central for active or sight-threatening disease. EUGOGO recommends intravenous methylprednisolone (IVMP) with mycophenolate sodium as first-line treatment for moderate-to-severe active TED, typically delivered as 4.5 g over 12 weeks. More intensive regimens are required for sight-threatening disease, with orbital decompression if response is inadequate. This study evaluates patient characteristics, treatment regimens, and outcomes at a tertiary referral centre.

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Methods

A retrospective review of electronic medical records was conducted for patients treated with IVMP for active TED at Moorfields Eye Hospital between January 2020 and June 2025. Demographic data, thyroid disease characteristics, smoking status, treatment indication, IVMP regimen, response, adverse events, and need for additional intervention were analysed.

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Results

Ninety-three patients were included (53% female), with a mean age of 56 years (range 17-77 years). Graves’ disease was the most common thyroid diagnosis (79%). The indication for IVMP was moderate-to-severe active TED in 75% and dysthyroid optic neuropathy in 25%. Most patients (77%) received the standard EUGOGO regimen, while 23% received modified protocols. The mean cumulative IVMP dose was 3.27 g (range 0.5-6 g). Visual acuity was stable or improved in 87.1% of patients. Treatment was discontinued in 11.8% due to adverse effects or inadequate response. Two patients required urgent orbital decompression, and raised intraocular pressure occurred in 5%. Outcomes were broadly comparable between standard and individualised regimens.

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Conclusion

This five-year tertiary-centre experience shows that IVMP remains an effective and generally well-tolerated treatment for active and sight-threatening TED in routine practice. Most patients achieved stable or improved visual outcomes, with low rates of major adverse events or treatment cessation. Comparable outcomes between standard and tailored protocols support the continued role of IVMP as first-line therapy.

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Additional Authors

First name	Last name	Base Hospital / Institution
Negin	Sanadgol	Moorfields Eye Hospital, London, United Kingdom
Jean-Paul	Rinne	UMC Utrecht, Department Ophthalmology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
Mana	Rahimzadeh	Moorfields Eye Hospital, London, United Kingdom
Shehnaz	Bazeer	Moorfields Eye Hospital, London, United Kingdom
Munazzah	Chou	Moorfields Eye Hospital, London, United Kingdom
Shivaa	Ramsewak	Moorfields Eye Hospital, London, United Kingdom
Jimmy	Uddin	Moorfields Eye Hospital, London, United Kingdom

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