Beleslin, Biljana Nedeljkovic (6701355427)Biljana Nedeljkovic (6701355427)BeleslinCiric, Jasmina (6601995819)Jasmina (6601995819)CiricZarkovic, Milos (7003498546)Milos (7003498546)ZarkovicStojkovic, Mirjana (7006722691)Mirjana (7006722691)StojkovicSavic, Slavica (35328081800)Slavica (35328081800)SavicKnezevic, Miroslav (36192212000)Miroslav (36192212000)KnezevicStankovic, Branislav (16205536900)Branislav (16205536900)StankovicTrbojevic, Bozo (6602073472)Bozo (6602073472)Trbojevic2025-06-122025-06-122014https://doi.org/10.1007/bf03401336https://www.scopus.com/inward/record.uri?eid=2-s2.0-84899656725&doi=10.1007%2fbf03401336&partnerID=40&md5=0212a5c3e471f7f1f2b7c1e65290a319https://remedy.med.bg.ac.rs/handle/123456789/8827Objective: Glucocorticoids (GC) are the treatment of choice for moderate-to-severe and active Graves' orbitopathy (GO), but optimal treatment is still undefined. The aim of the present study was to analyze the efficacy and tolerability of combined parenteral GC pulse therapy followed by oral GC in the interpulse period. Design: The study included 50 patients (48±10 years; 37 female) with untreated, active and moderate-to-severe GO. Patients received 500mg of methylprednisolone in 500ml of physiologic saline. Infusion was repeated after 48h and then followed by tapering doses of oral prednisone and the cycle repeated each month for the next 5 months. The cumulative dose was 10.2g. Ophthalmic assessment was performed before and 6 months after start of treatment. Side effects of GC therapy were evaluated and recorded each month. RESU LTS: GC showed the greatest effectiveness on soft tissue changes (incorporated in the CAS). Median CAS values decreased from 4.5 to 2 (p>0.001). Improvement was demonstrated in 37 patients (74%), there was no change in 13 patients (26%) and none of the patients presented with deterioration of inflammatory status. Diplopia improved in 21 patients (42%), was unchanged in 28 patients (56%) and deteriorated in 1 patient (2%). Improvement in visual acuity occurred in 36% of patients. At 6 months, 33/50 patients (66%) demonstrated overall treatment response. Response to GC therapy was influenced by CAS, TSHRAb and smoking behavior. The only independent parameter associated with positive treatment response was CAS ≥4 (p<0.001). Side effects occurred in 35/50 patients (70%) and the vast majority of them were mild to moderate. During the 6-months follow-up period, 2/33 patients (6%) had relapsing GO. Conclus Ion: With appropriate selection of patients and careful monitoring during and after treatment, combined parenteral and oral GC therapy is effective and safe.GlucocorticoidsGraves' orbitopathy