Abstract Listings 2026

Purpose

To identify biomarkers of response to IV methylprednisolone (IVMP) treatment for moderate-to-severe active thyroid eye disease (TED).

Methods

We retrospectively analyzed pre-treatment orbital MRI biomarkers, including extraocular muscle (EOM) diameter, EOM signal intensity ratios (SIR) and relative apparent diffusion coefficient compared with temporalis muscle, and clinical variables like clinical activity score (CAS) disease duration and TSH-receptor antibody levels from 57 patients with active (CAS ≥ 3) TED treated with IVMP (standard 12-week EUGOGO regimen; total of 4,5g IVMP). Patients were divided into three groups: no improvement, improvement or worsening.

Results

SIR (mean, medial, superior and inferior recti) were the strongest predictors of treatment response. After false discovery rate adjustment, these SIR variables achieved q-values < 0.003. Post-hoc pairwise comparisons demonstrated that SIR values were significantly higher in patients with any response (improvement or worsening) compared to non-responders (p < 0.05), while there was a trend towards higher SIR values in patients showing clinical worsening despite treatment. This pattern suggests that SIR may serve as a biomarker for identifying patients likely to exhibit a therapeutic response to IVMP, and possibly also indicating which patients may need higher doses of steroids. While disease duration showed a trend toward significance, with shorter duration associated with better outcomes, the small sample size limited statistical power for this variable.

Conclusion

These findings demonstrate the potential of MRI-derived markers, in particular SIR, as an objective tool to improve patient selection for IVMP in active moderate-to-severe TED, though validation in larger cohorts is needed.

Additional Authors

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