Effectiveness of intravenous glucocorticoids in active thyroid eye disease patients with low clinical activity scores.

Purpose: To assess and predict the therapeutic efficacy of intravenous glucocorticoids (IVGC) in thyroid eye disease (TED) patients with clinical activity score (CAS) < 3, but presenting magnetic resonance imaging (MRI)-confirmed intraorbital inflammation.

Methods: We retrospectively analyzed the clinical data of 91 active TED patients with low CAS that received IVGC treatment (4.5 g, 12 weeks). In terms of treatment response evaluation, the EUGOGO standard (Two-Item Standard) and a One-Item Standard modified on this basis were implemented. Univariate and multivariable logistic regression analyses were used to establish prediction models. Receiver operating characteristic (ROC) curve analysis was performed and the area under the curve (AUC) was calculated.

Results: Under Two-Item Standard, 31 of the 91 patients (34.1%) were determined as responsive to IVGC, and 60 (65.9%) were unresponsive. MRD-1 was significantly different between responsive and unresponsive groups (P-value < 0.05). Under One-Item Standard, 43 (47.3%) were responsive, and 48 (52.7%) were unresponsive. MRD-2 and exophthalmos were significantly different between two groups (P-value < 0.05). By implementing multivariable regression, the reliability of predicting treatment response of IVGC in active TED patients with low CAS reached AUC = 0.709 under the Two-Item Standard and AUC = 0.792 under the One-Item Standard.

Conclusion: It is suggested that MRI-based intraorbital active TED patients with low CAS and significant symptoms should be considered for anti-inflammatory therapy, particularly those with specific clinical and radiological features. Clinical assessment and radiological evaluations are valuable for predicting IVGC effectiveness and achieving precision treatment.