RESUMEN
The aim of the present study was to analyze the effects of methylprednisolone pulse therapy (MPPT) courses on bone metabolism in patients with Graves' ophthalmopathy (GO). A retrospective analysis of 45 patients with moderate-to-severe active GO who received 1 or 2 courses of MPPT was performed. Of these, 16 patients underwent 2 courses of treatment. Bone metabolic markers and the density of the lumbar spine (L1-4), femoral neck and total hip were measured using a dual-energy X-ray bone density instrument, and the differences in bone metabolism prior to and after treatment were determined for each group and compared. The results indicated that serum I collagen N-terminal peptide (P1NP) and serum ß-collagen crosslinked C-terminal peptide (CTX) were markedly decreased after the first pulse of treatment. In those patients who received a second course of MPPT, CTX levels were significantly decreased, but P1NP was not significantly different from the baseline value. CTX and P1NP levels remained unchanged between the first and second course of MPPT; similarly, there were no changes from baseline in 25(OH) vitamin D3 and bone mineral density after the first and second course of MPPT. However, the level of 25(OH) vitamin D3 was significantly elevated after the second course compared with the first course. In conclusion, the side effects of MPPT on bone metabolism were marginal and a second course of MPPT did not worsen bone metabolism. These MPPT regimens may therefore be considered to be a safe and effective treatment option for patients with moderate-to-severe active GO.
RESUMEN
OBJECTIVE: Management of Graves' orbitopathy (GO) continues to be a challenge to clinical endocrinologists. In the last few years, surveys on GO management have succeeded in elucidating trends in Europe and Latin America. To determine how endocrinologists in China assess and treat patients with GO and gain insight into how to make the management of this disease more uniform and standardized. METHODS: Based on the questionnaire used in the European survey on GO, a questionnaire in China was drafted and circulated to the members of Chinese Society of Endocrinology (CSE) during the annual meeting. RESULTS: A total of 124 valid responses were analysed. Almost all respondents (94.4%) claimed that a multidisciplinary approach for GO management was valuable. Over 80% of the participants advocated the assessment of exophthalmometry, vision, visual fields by perimetry, eye movements, and fundoscopy. Glucocorticoids were preferred as the first-line therapy by 92.7% of respondents, among them, 59.7% choose the intravenous route. The treatment strategy for GO with intravenous glucocorticoids therapy still remains debatable. Anti-thyroid drugs (ATDs) were the most common choice (72.6%) for first-line therapy of coexisting hyperthyroidism. Treatment options for GO were very similar among Chinese, Latin-American and European respondents, whereas radioactive iodine and surgical treatment were more often indicated for co-existing hyperthyroidism in China. CONCLUSION: The appropriate treatment for patients with GO is controversial even among thyroid specialists. Further training of thyroid specialists, easier access of patients to multidisciplinary centres and establishment of practice guidelines are required for the management of this condition in China.