High-dose intravenous pulse therapy with methylprednisolone and orbital irradiation in graves' ophthalmopathy

Pulse therapy with steroids has been advocated as an effective therapy for Graves' ophthalmopathy, followed or not by external radiotherapy, if more than one course fails or when side effects are not tolerated. Nineteen patients with Graves' ophthalmopathy were treated with methylprednisolone IV purses and a maintenance oral prednisone dose be tween pulses, Ten patients subsequently were submitted to orbital radiotherapy because of recurrence of inflammatory signs and symptoms. Eight patients exhibited significant improvement after pulse therapy, and seven patients had a lesser response; inflammation showed significant regression in most patients, and proptosis improved in eight. Radiotherapy resulted in slight improvement in three patients and significant improvement in the other four. Proptosis regressed partially in three patients and completely in two. Diplopia disappeared in one patient, and visual acuity improved in five. Our results with steroid pulse therapy are comparable with other series reported in the literature, while other results with radiotherapy are less favorable.