Impact of additional intravenous methylprednisolone pulse therapy on the quality of life in patients with dysthyroid optic neuropathy

Maryla Pelewicz; Joanna  Rymuza; Katarzyna Pelewicz; Piotr Miśkiewicz

doi:10.20883/medical.e519

Authors

Maryla Pelewicz Student Scientific Group “Endocrinus”, Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland
Joanna Rymuza Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland https://orcid.org/0000-0003-2427-0489
Katarzyna Pelewicz Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland https://orcid.org/0000-0002-2333-2337
Piotr Miśkiewicz Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Poland https://orcid.org/0000-0003-4015-6491

DOI:

https://doi.org/10.20883/medical.e519

Keywords:

Graves orbitopathy, dysthyroid optic neuropathy, quality of life, visual acuity, diplopia

Abstract

Introduction. Dysthyroid optic neuropathy (DON) is a severe complication of Graves’ orbitopathy (GO). Treatment of DON should involve immediate administration of intravenous methylprednisolone (ivMP) in very high doses. It is recommended to include additional 12 pulses of ivMP according to a weekly schedule as a further step of the treatment process. The purpose of this study was to evaluate the influence of a 12-week ivMP treatment on the quality of life (QoL) in DON patients.

Material and Methods. A retrospective study was conducted on 6 patients (the tests involved 8 individual eyes) with DON and treated with ivMP in very high doses, followed by orbital decompression in one patient. All patients were qualified for additional treatment with ivMP in a 12-week protocol and completed the Polish version of the GOQoL questionnaire before and after the therapy. Visual acuity (VA) and diplopia were examined prior to the administration of ivMP pulses for DON, as well as before and after the additional ivMP treatment.

Results. A minimal clinically important difference in QoL was observed in four patients at the end of the additional ivMP therapy. A significant increase in VA was observed following additional pulses of ivMP compared to the evaluation at the time of the DON diagnosis (p=0.04).

Conclusions. Applying additional 12 pulses of ivMP following DON therapy may impact QoL. Performing QoL assessment throughout the entire therapy in patients with DON is particularly important in the clinical practice. Final evaluation of QoL should be performed after completing the entire therapeutic process, which involves surgical treatment to correct diplopia.

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References

Burch HB, Wartofsky L. Graves’ ophthalmopathy: Current concepts regarding pathogenesis and management. Endocrine Reviews. 1993;14(6):747-793. https://doi.org/10.1210/edrv-14-6-747 PMID 10.1210/edrv-14-6-747

Weetman AP. Thyroid-associated eye disease: pathophysiology.. Lancet (London, England). 1991 Jul;338(8758):25-28. https://doi.org/10.1016/0140-6736(91)90013-f PMID 10.1016/0140-6736(91)90013-f

Wiersinga WM. Autoimmunity in Graves' ophthalmopathy: The result of an unfortunate marriage between TSH receptors and IGF-1 receptors?. Journal of Clinical Endocrinology and Metabolism. 2011;96(8):2386-2394. https://doi.org/10.1210/jc.2011-0307 PMID 10.1210/jc.2011-0307

Neigel JM, Rootman J, Belkin RI, Nugent RA, Drance SM, Beattie CW, Spinelli JA. Dysthyroid optic neuropathy. The crowded orbital apex syndrome.. Ophthalmology. 1988 Nov;95(11):1515-1521. https://doi.org/10.1016/s0161-6420(88)32978-7 PMID 10.1016/s0161-6420(88)32978-7

Kennerdell JS, Rosenbaum AE, El-Hoshy MH. Apical optic nerve compression of dysthyroid optic neuropathy on computed tomography.. Archives of ophthalmology (Chicago, Ill. : 1960). 1981 May;99(5):807-809. https://doi.org/10.1001/archopht.1981.03930010807002 PMID 10.1001/archopht.1981.03930010807002

Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, Perros P, Salvi M, Wiersinga WM. The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy.. European thyroid journal. 2016 Mar;5(1):9-26. https://doi.org/10.1159/000443828 PMID 10.1159/000443828

Gerding MN, Terwee CB, Dekker FW, Koornneef L, Prummel MF, Wiersinga WM. Quality of life in patients with Graves' ophthalmopathy is markedly decreased: measurement by the medical outcomes study instrument.. Thyroid : official journal of the American Thyroid Association. 1997 Dec;7(6):885-889. https://doi.org/10.1089/thy.1997.7.885 PMID 10.1089/thy.1997.7.885

Kulig G, Andrysiak-Mamos E, Sowińska-Przepiera E, Kulig J, Karakiewicz B, Brodowski J, Robaczyk M, Homa K, Letkiewicz M, Syrenicz A. Quality of life assessment in patients with Graves' disease and progressive infiltrative ophthalmopathy during combined treatment with methylprednisolone and orbital radiotherapy.. Endokrynologia Polska. 2009;60(3):158-165.

Du Y, Ye H, Li K, Xiao X, Chen R, He J, Yang H. Vision-related quality of life tends to be more severely impaired in patients with dysthyroid optic neuropathy.. Current eye research. 2014 May;39(5):532-536. https://doi.org/10.3109/02713683.2013.848901 PMID 10.3109/02713683.2013.848901

Lee THB, Sundar G. Quality of Life in Thyroid Eye Disease: A Systematic Review.. Ophthalmic plastic and reconstructive surgery. 2020;36(2):118-126. https://doi.org/10.1097/IOP.0000000000001446 PMID 10.1097/IOP.0000000000001446

Sawicka-Gutaj N, Bednarczuk T, Daroszewski J, Waligórska-Stachura J, Miśkiewicz P, Sowiński J, Bolanowski M, Ruchała M. GO-QOL--disease-specific quality of life questionnaire in Graves' orbitopathy.. Endokrynologia Polska. 2015;66(4):362-366. https://doi.org/10.5603/EP.2015.0046 PMID 10.5603/EP.2015.0046

Miśkiewicz P, Rutkowska B, Jabłońska A, Krzeski A, Trautsolt-Jeziorska K, Kęcik D, Milczarek-Banach J, Pirko-Kotela K, Samsel A, Bednarczuk T. Complete recovery of visual acuity as the main goal of treatment in patients with dysthyroid optic neuropathy.. Endokrynologia Polska. 2016;67(2):166-173. https://doi.org/10.5603/EP.a2016.0018 PMID 10.5603/EP.a2016.0018

Bahn RS, Gorman CA. Choice of therapy and criteria for assessing treatment outcome in thyroid-associated ophthalmopathy.. Endocrinology and metabolism clinics of North America. 1987 Jun;16(2):391-407.

Wiersinga WM, Prummel MF, Terwee CB. Effects of Graves' ophthalmopathy on quality of life.. Journal of endocrinological investigation. 2004 Mar;27(3):259-264. https://doi.org/10.1007/BF03345275 PMID 10.1007/BF03345275

Vogel A, Elberling T, Hørding M, Dock J, Rasmussen AK, Feldt-Rasmussen U, Perrild H, Waldemar G. Affective symptoms and cognitive functions in the acute phase of Graves' thyrotoxicosis.. Psychoneuroendocrinology. 2007 Jan;32(1):36-43. https://doi.org/10.1016/j.psyneuen.2006.09.012 PMID 10.1016/j.psyneuen.2006.09.012

Miśkiewicz P, Kryczka A, Ambroziak U, Rutkowska B, Główczyńska R, Opolski G, Kahaly G, Bednarczuk T. Is high dose intravenous methylprednisolone pulse therapy in patients with Graves' orbitopathy safe?. Endokrynologia Polska. 2014;65(5):402-413. https://doi.org/10.5603/EP.2014.0056 PMID 10.5603/EP.2014.0056