Purpose

To evaluate clinical and biochemical determinants of early vs late escalation to intravenous methylprednisolone (IVMP) for the management in thyroid eye disease (TED).

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Methods

A retrospective cohort study was conducted at Moorfields Eye Hospital of TED patients who received IVMP between 2020 and 2025. The primary outcome was time from thyroid disease diagnosis to first IVMP, dichotomised at 12 months into early and late escalation groups. A total of 36 candidate predictors were assessed, including sex, smoking history, Clinical Activity Score (CAS), initial eye symptoms (diplopia, swelling, irritation, proptosis, reduced vision, epiphora, pain, and redness), ophthalmic signs (motility, lid swelling, chemosis, colour vision), thyroid function (TSH, T4, T3, fluctuating TFTs, TRAb, TPO), and co-morbidities. Univariable logistic regression was performed.

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Results

Ninety-three patients were included (53% female, 47% male), with a mean age of 56 years (range 19–77). Diagnoses included Graves’ disease (79%), euthyroid TED (9%), unspecified hyperthyroidism (7%), and hypothyroidism (5.3%). Smoking status was current (25%), ex-smoker (25%), non-smoker (25%), and unknown (26%). Indications were dysthyroid optic neuropathy in 25% and moderate-to-severe TED in 75%. Median time from thyroid diagnosis to IVMP was 20.0 months (IQR 8.5–50.5). 35.6% of patients required IVMP within 12 months of systemic thyroid disease diagnosis. Male sex was independently associated with early escalation (OR 3.85, 95% CI 1.24–11.88, p=0.019), Smoking demonstrated a trend towards earlier escalation, though this did not reach significance.

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Conclusion

Considerable inter-patient variability exists in time to IVMP escalation in TED. Male sex was found to be an independent predictor of earlier treatment. This may reflect gender differences in eye disease phenotype and severity or may be related to differences in health-seeking behaviours, for example. These findings warrant further investigation in larger cohorts to better characterise determinants of rapid disease progression and inform earlier therapeutic intervention.

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Additional Authors

First name	Last name	Base Hospital / Institution
Munazzah	Chou	Moorfields Eye Hospital
Mana	Rahimzadeh	Moorfields Eye Hospital
Nicole	Quah	Moorfields Eye Hospital
Shivaa	Ramsewak	Moorfields Eye Hospital
Shehnaz	Bazeer	Moorfields Eye Hospital
Jean Paul	Renne	Moorfields Eye Hospital
Jimmy	Uddin	Moorfields Eye Hospital

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