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A Journal on Ophthalmology
Minerva Oftalmologica 2013 December;55(4):87-91
Methotrexate as alternative therapy in thyroid eye desease
Ferrara M., Strianese D., Comune C., Carandente R., D’alessandro A., Ruggiero P., Napolitano P., Bonavolontà G.
Dipartimento di Scienze Oftalmologiche Università degli Studi di Napoli “Federico II” , Napoli, Italia
Aim: The aim of the study was to evaluate the efficacy of methotrexate administered for thyroid eye disease as an alternative treatment.
Methods: Thirty-six consecutive patients with active thyroid eye disease who stopped steroid for occurrence of side effects received methotrexate at two different weekly doses depending on the weight of the patient (from 7.5 mg to 10 mg). Their records were retrospectively reviewed to evaluate: clinical activity score (CAS), visual acuity (VA), gaze restriction, exophthalmos and eyelid position at 3, 6 and 12 months compared with baseline data.
Results: Methotrexate was well tolerated. Statistically significant improvement of clinical activity score was observed at 3, 6 and 12 months (P<0.0001). Visual acuity did not vary significantly. Gaze restriction improved at 6 and 12 months visit (P<0.001). Initial exophthalmos and eyelid position remained unvaried. No side effects were registered.
Conclusion: This therapy was useful to reduce the signs and symptoms of inflammation and to shorten the active phase since in all patients there was a statistically significant decrease of the inflammatory score. So methotrexate therapy might be considered a suitable alternative treatment for active thyroid eye disease in those patients who cannot tolerate the steroids. No significant improvement of the proptosis and the eyelid retraction should be expected.