Steroids in Graves’ Eye Disease

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Question

I have a question regarding standard protocols for IV glucocorticoid therapy for Graves ophthalmopathy w/ constant diplopia. Is there a “best practices” protocol now established? I’ve just completed pulse IV therapy of 3 days, every other day, 1000 mg Solumedrol each session. I’m wondering if this is typically repeated, is followed by oral prednisone, or is considered sufficient? Thank you for your answer. p.s. I am also considering selenium supplementation (100 mcg bid) since there appears to be some suggestion this could be helpful…

Response

Your questions are very pertinent. There is no general agreement on ‘the best’ protocol for steroid administration. A reasonable strategy is administration of 0.5 gram of methylprednisone on 3 consecutive days, repeated weekly to achieve a total dose of 4.5grams. Some clinicians also follow with oral prednisone, 40mg/day, depending on the severity and response to the intravenous administration. Higher intravenous doses have been used, but a total dose of more than 6-10 grams is considered to risk serious side effects. The regime that you received is reasonable and commonly given. The reason that no agreed protocol exists is that no prospective randomised trials have been published comparing different regimes. However the European Group on Graves’ Orbitopathy (EUGOGO) is conducting such a trial and the results will be published in the next 18 months. EUGOGO has just completed a randomised trial of Selenium in mild orbitopathy (not as severe as requiring iv steroids). Selenium is beneficial in this type of GO and these data are being submitted for publication..

Yours sincerely,

John Lazarus, MD