Steroid therapy for Graves' ophthalmopathy

Glucocorticoids are usually given for management of Graves' ophthalmopathy (GO) for their anti-inflammatory and immunosuppressive effects. The overall rate of favorable response for moderately severe and active GO is 77% in patients treated with methylprednisolone iv pulse therapy. When radioiodine therapy is indicated for hyperthyroidism in Graves' patients with high risk factors, the use of glucocorticoid with small doses and short periods is recommended to prevent the development or progression of GO. Cushingoid features, glucose intolerance, gastritis, hypertension, hepatitis, and depression are major adverse effects of glucocorticoids. Fatal liver failure after high dose of pulse therapy (9-12g) was observed in 0.8%. Limiting the cumulative dose to 4.5-6g, assessment of liver virus markers and monitoring liver function before, during and after i.v. treatment are warranted.