How Are Steroids Used to Treat Thyroid Eye Disease?

Thyroid eye disease (TED) is a rare, progressive autoimmune disease that affects the tissues in and around the eyes. In TED, the body’s own immune system incorrectly targets and harms healthy tissue. TED causes inflammation, swelling, irritation, and sometimes vision problems.¹

Steroids, also called glucocorticoids or corticosteroids, are a type of drug used to treat TED in the active phase. Steroids are effective anti-inflammatories used to decrease the inflammation and swelling caused by TED.^1,2

How do steroids work?

Steroids are strong anti-inflammatory drugs. When given in doses higher in amount than your body normally makes, steroids quickly decrease inflammation.³

In TED, high-dose steroids are vital to help prevent vision loss and decrease severe swelling and inflammation during the acute phase. During this phase, swelling of the fat and tissues behind the eye can squeeze and damage the optic nerve in the eye. Optic nerve compression is an emergency and can lead to vision loss if not quickly treated.²

TED involves tissue damage caused by inflammation in and around the eyes. The goal of steroid treatment is to control that inflammation and stop acute damage.²

Examples of steroids

In TED, steroids can be given in different ways:²

• Direct injection into the orbit (bony cavity of the skull where the eyeball sits)
• Intravenous infusion (IV, through the vein)
• Orally (swallowed tablets)

There are many different types of steroids available. The most common IV steroid used for TED is Solu-Medrol® (methylprednisolone sodium succinate). Oral steroids may be prescribed instead of or after IV or injected therapy. Prednisone and prednisolone are the most common oral steroids used.²

What are the possible side effects of steroids?

Steroids are strong drugs that can be effective in decreasing inflammation in TED. However, the benefits of taking steroids must be weighed against the many possible side effects known to result from long-term use, especially at high doses.³

Short-term side effects of steroids may include:³

• High blood pressure
• Mental effects like mood swings, behavior changes, anxiety, restlessness
• Nausea
• High blood sugar, which can cause the onset of or worsen diabetes

Side effects of long-term steroid use may include:³

• Fluid retention
• Stomach ulcers
• Round appearance to the face (moon face)
• Weakening of bones (osteoporosis), which increases the risk of fractures
• Weight gain
• Increased pressure in the eye (glaucoma)
• Decreased adrenal gland hormone, which can lead to severe fatigue, muscle weakness, and loss of appetite
• increased risk of infection

These are not all the possible side effects of steroids. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with steroids.

Other things to know

It is hard to know how fast or how completely steroids will work for each person. Steroids may or may not be effective for you.

It is common for doctors to prescribe high-dose IV Solu-Medrol for an acute attack (rapid onset of symptoms) of TED. Rapidly decreasing inflammation in and around your eyes may be needed in order to prevent vision loss.²

The length of time for IV and injected therapy in TED varies from person to person. The decision to continue steroids or add a new treatment is based on your symptoms, MRI or CT findings, and how you are tolerating the therapy. Steroids may be continued in tablet form for a period of time after IV therapy.²

Your doctor may also prescribe other drugs to help reduce the chances of stomach ulcers while you are taking steroids.

High-dose steroids do not prevent further attacks of TED. This means steroids are not disease-modifying. Because of this, your TED specialist might prescribe other drugs and treatments to target the harmful antibodies that lead to swelling.²

Low-dose steroids may be needed for long-term therapy. Talk to your doctor about your treatment plan, as well as the risks and benefits of all drugs.²

Before beginning treatment for TED, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.