Abstract Listings 2024

Purpose

Objectives
• Designing an oral Methylprednisolone regimen that is comparable to the IV
Methylprednisolone in managing active Thyroid eye disease.
• Completing a health screening questionnaire and undergo systemic investigations to
ensure there are no contraindications.
• Formulating a close follow up plan for the patients including baseline and follow up
laboratory investigations for early detection of any blood electrolyte abnormalities or
hepatotoxicity.
• Comparing the results of our study to the gold standard which is the IV
Methylprednisolone.

Methods

• Patients with active Thyroid Orbitopathy with CAS>3 who are considered for starting
systemic pulsed Oral Methylprednisolone receive verbal and written information,
counselling about their condition, indication for treatment and potential side effects.
• They undergo systemic investigations: chest x-ray, baseline bloods including full
blood count (FBC), Urea and electrolytes (U&Es), liver function test (LFT), Blood
pressure, capillary blood glucose level to ensure there are no contraindications to the
use of steroids. In young females, pregnancy test is considered if relevant.
• The dose may need to be adjusted if there are co-morbidities that may increase the
risk of the side-effect profile.
• Steroid advice card is provided.
• Treatment with Oral Methylprednisolone is commenced once the results of the
investigations are back. However, if there is a sight threatening emergency, then they
should be admitted and started on 1g IV Methylprednisolone.
• The regimen for Oral Methylprednisolone is 600mg per week in 3 divided doses of
200mg (Monday, Wednesday & Friday) for 6 weeks, then 300mg per week in 3
divided doses of 100mg (Monday, Wednesday & Friday) for 6 weeks.
• Lansoprazole 30mg once daily and Adcal D3 chewable tablets twice daily are started
concurrently for the duration of the oral steroids course.
• Systemic bloods (FBC, U&Es and LFTs) should be repeated at week 4, week 8, and
week 12 to check for possible blood electrolyte abnormalities or hepatotoxicity.

Results

During our study period, 4 patients were diagnosed with active thyroid orbitopathy, 3 of the
patient had a CAS 4, and 1 with CAS 3 at baseline. The mean age in this cohort is 53.2 years
old with 4 female patients. 2 patients were non-smoker, 1 current smoker, 1 patient smoking
status is unknown. All patients had normal optic nerve function and there was no cornea
involvement during initial presentation. After 8 weeks of completing the treatment course,
all 4 patients had CAS 0. There was no reported adverse effect during the course of
treatment.

Conclusion

In conclusion, based on our series of cases, we have found that treating patients with active
thyroid orbitopathy with pulsed oral methylprednisolone yields excellent improvement in
CAS score with minimal adverse effect. Despite the study has a small cohort of patients,
there is a role for pulsed oral methylprednisolone in the management of active thyroid
orbitopathy.

Additional Authors

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