Role of concurrent intravenous pulse steroids and orbital radiation in the management of thyroid eye disease

Abstract: PURPOSE: To analyze the outcomes of concurrent intravenous pulse steroids and orbital radiation (ORT) in thyroid eye disease (TED). METHODS: It was a retrospective interventional study. Medical records of patients presenting with clinically or radiologically active TED with diplopia were reviewed. All patients received concurrent ORT (20 Gy in 10 fractions) and 500 mg of pulsed intravenous methylprednisolone (IVMP). The response to treatment was assessed using International Thyroid Eye Disease Society-Vision, Inflammation, Strabismus, and Appearance scoring system. RESULTS: Forty-eight orbits of 24 patients were included in the study. There was an equal male and female (12 each) distribution. The mean age at presentation was 53.6 ± 11.4 years (range: 38–73 years). The median duration of orbital disease was 5.5 months (range 1–96 months). Diplopia (22, 91.66%) was the most common presenting complaint. Posttreatment, there was a significant reduction in the mean inflammatory score ( P < 0.05). Complete resolution of diplopia was seen in 82.6% ( P = 0.0009) patients and a significant improvement in extraocular motility was seen in 95.8% of patients ( P < 0.05). Prism glasses were prescribed in two patients for residual diplopia. The mean follow-up period was 20 ± 16.506 months (median 19 months, range: 3–60 months). No significant complication was noted at the last follow-up in any of the patients. CONCLUSION: Concurrent pulse IVMP with ORT is a safe and effective treatment modality for TED-related diplopia. An appropriate selection of cases along with a pretreatment magnetic resonance imaging to look for radiologically active disease aids in better planning and understanding of the disease.