Prognostic factors for determining the therapeutic response in patients with active moderate-severe and severe thyroid-associated ophthalmopathy

General Medicine, 2025, 27(4), 47-51.

M. Stoynova, Al. Shinkov, R. Kovacheva

Department of Endocrinology, Medical University ‒ Sofia

Abstract. In the treatment of active moderate-to-severe form of thyroid-associated ophthalmopathy (TAO), various immunomodulatory agents are used, none of which provides 100% effectiveness, and complete reversal of ocular manifestations is rarely achieved. Various clinical, biochemical and imaging indicators have been studied as predictors of therapeutic response. Data regarding the relationship between gender and age, and therapeutic efficacy are contradictory. Smoking is associated with a poor prognosis of TAO and resistance to immunomodulatory agents. CAS is currently considered the most reliable clinical indicator for predicting the effect of immunosuppressive treatment, although it lacks complete objectivity and accuracy. Magnetic resonance imaging of the retroorbital spaces could provide a good assessment of disease activity and select patients in whom a response to immunosuppressive treatment is expected. TAO duration also has a predictive value, as the therapeutic response is significantly weaker when the disease has been present for more than 18 months. High baseline TRAb is an indicator of a poor prognosis of TAO. Other markers whose prognostic potential has been studied are: inflammatory cytokines, micro-RNA, polymorphisms of the glucocorticoid receptor. More detailed studies of TAO markers are needed to validate their prognostic value in terms of therapeutic efficacy and to develop complex models for the analysis of the individual sensitivity to GC treatment.

Key words: thyroid-associated ophthalmopathy, therapeutic efficacy, predictors

Address for correspondence: Maria Stoynova, MD, e-mail: mariya.stoynova@abv.bg