A Preliminary Clinical Study Of Different Regimens Of Intravenous Glucocorticoid For Patients With Thyroid-associated Ophthalmopathy

Chapter I Comparison of the efficacy and safety of different regimens of intravenous glucocorticoid for patients with thyroid-associated ophthalmopathyObjective Due to the large heterogeneity of clinical manifestations,severity,and activity in patients with moderate to severe active thyroid-associated ophthalmopathy,the EUGOGO guideline recommended a cumulative dose of 4.5g weekly protocol has poor efficacy in some patients.And TAO patients in different places have relatively poor compliance with the weekly protocol.So this study intends to explore the alternate-day protocol,and compares its efficacy and safety with the weekly protocol.Methods A total of 51 patients with moderate to severe active thyroid-associated ophthalmopathy who met the inclusion criteria in the Third Affiliated Hospital of Southern Medical University were selected and randomly divided into weekly protocol group and the alternate-day protocol group.The two groups of patients were evaluated for ocular symptoms and signs,GO-QOL scale scores at each visit.At the same time,the incidence of adverse events were recorded.Results1.There were no significant differences in baseline data such as gender and age between the two groups of patients..2.At the end of treatment,the overall effective rate of eyes in the alternate-day protocol was 73.1%,and that in the weekly protocol was 68.0%.Patients in both groups showed significant CAS response,palpebral aperture response,exophthalmos response,soft tissue response,diplopia response and the scores of GO-QOL.There were no significant differences in the degree of improvement between the two groups.3.Follow-up of patients 3-6 months after treatment and 1 year after treatment,the CAS,palpebral aperture,exophthalmos and the scores of GO-QOL have no significant differences with time.The weekly protocol group got the same result.4.The total incidence of adverse events in the alternate-day protocol group was 46.2%,and that in the weekly protocol group was 40.0%.There was no significant statistical difference between the two groups.Conclusion Both the alternate-day protocol and the weekly protocol have good effectiveness,stability and safety.The two protocols have no significant differences in efficacy and safety.The best plan can be selected according to the actual needs of TAO patients.Chapter Ⅱ A Study on the changes of extraocular muscle MRI of different regimens of intravenous glucocorticoid for patients with thyroid-associated ophthalmopathyObjective To explore the changes of extraocular muscle MRI of different regimens of intravenous glucocorticoid for patients with thyroid-associated ophthalmopathy,and to explore the value of STIR and T2 mapping sequence in evaluating the efficacy of different treatment regimens in combination with clinical indicators.Methods The research objects in this chapter were the same group of patients as in Chapter 1.There were 23 patients underwent orbital MRI scans before treatment and half a year to 1.5 years after treatment.Among them,there were 11 patients in the weekly protocol group and 12 patients in the alternate-day protocol group.We analyzed the changes in MRI of the two groups of patients before and after treatment..Results1.The coefficient of variation of the coefficient of variation of the two measurers was within the acceptable range,and the correlation coefficient within the group was greater than 0.8.2.After treatment,SIR of the two groups of patients decreased compared with before treatment,and there was no statistically significant difference in SIR change between the two groups.3.After treatment,T2RT of the two groups of patients decreased compared with before treatment,and there was no significant statistical difference in the amount of T2RT change between the two groups.4.After treatment,the cross-sectional area of the extraocular muscles of the two groups decreased compared with before treatment,and there was no significant statistical difference in the area change between the two groups.Conclusion There is no significant difference in the changes of extraocular muscle MRI between the alternate-day protocol and the weekly protocol group,which is consistent with the clinical treatment effective rate.The MRI STIR and T2 mapping sequence are helpful for the efficacy monitoring and can be used to analyze the efficacy of different treatment options.