Purpose

To evaluate the efficacy and safety of combined intravenous methylprednisolone (IVMP) and orbital radiotherapy (DXT) in active, moderate-to-severe thyroid eye disease (TED) in an Asian population.

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Methods

Retrospective review of all patients who were treated with IVMP for TED from May 2024 to May 2025 in a Tertiary Asian Centre.

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Results

22 patients were included with a mean age of 57.2 +/- 13 years old. 86.4% were Chinese with the remaining 13.6% Malay. 72.7% were female. Adjunctive DXT (20 Gy) was administered to 68.2% (n=15). Dysthyroid Optic Neuropathy (DON) was present in 5 patients (22.7%). The median interval from first clinic visit to IVMP initiation was 1.5 months (mean: 5.1 months). Excluding two outliers with reactivated disease, the mean interval from hyperthyroidism diagnosis to first presentation of ocular symptoms was 4.85 months. Mean proptosis reduction was 7.1% at 6 months and 10.7% at 1 year (peak: 18.4%). Colour vision improved from 12.1/15 (baseline) to 14.4/15 (6 months), reaching 100% recovery (15/15) by 12 months. Elevation was affected in most patients. Extraocular movement (EOM) improvement occurred across all direction, notably in elevation and adduction. Steroid-related adverse events occurred in 18.2% (hyperglycemia, transaminitis, hypertensive urgency). 13.6% (3/22) required surgical decompression within one year, all of whom presented with DON.

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Conclusion

This combined approach of IVMP and DXT is a robust regimen for arresting the progression of moderate-to-severe thyroid orbitopathy in an Asian population. The therapy yields significant functional recovery and maintains a low requirement for early surgical decompression.

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Additional Authors

First name	Last name	Base Hospital / Institution
Hsi Wei	Chung	Singapore National Eye Centre

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