{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:32:46Z","timestamp":1760239966950,"version":"build-2065373602"},"reference-count":19,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2019,1,8]],"date-time":"2019-01-08T00:00:00Z","timestamp":1546905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Ophthalmopathy is a rare extra-thyroid manifestation of Graves\u2019 disease, in paediatrics. Intravenous corticosteroids are the main treatment of moderate-to-severe Graves\u2019 orbitopathy. In this paper, we describe a moderate-to-severe active Graves\u2019 ophthalmopathy in a child and the response to oral therapy with prednisone. Case presentation: A nine-year-old male child suffering for a few months, from palpitations, tremors, and paresthesia was hospitalized in our Pediatric Clinic. At admission, the thyroid function laboratory tests showed hyperthyroidism with elevated free thyroxine (FT4) and free triiodothyronine (FT3) levels and suppressed thyroid-stimulating hormone (TSH) levels. These findings, combined with the clinical conditions\u2014an ophthalmologic evaluation (that showed the presence of exophthalmos without lagophthalmos and visual acuity deficiency), thyroid ultrasound, and TSH receptor antibody positivity\u2014led to a diagnosis of Graves\u2019 disease. Therefore, methimazole was administered at a dose of 0.4 mg\/kg\/day. After 4 months, thyroid function was clearly improved, with normal FT3 and FT4 values and increasing TSH values, without adverse effects. Nevertheless, an eye examination showed ophthalmopathy with signs of activity, an increase in the exophthalmos of the right eye with palpebral retraction, soft tissue involvement (succulent and oedematous eyelids, caruncle and conjunctival hyperaemia and oedema) and keratopathy, resulting from exposure. We began steroid therapy with oral administration of prednisone (1 mg\/kg\/day) for four weeks, followed by gradual tapering. After one week of therapy with prednisone, an eye assessment showed reduced retraction of the upper eyelid of the right eye, improvement of right eye exophthalmometry and reduction of conjunctival hyperaemia. After four weeks of therapy with prednisone, an eye assessment showed reduction of the right palpebral retraction without conjunctival hyperaemia and no other signs of inflammation of the anterior segment; after twelve weeks, an eye assessment showed a notable decrease in the right palpebral retraction and the absence of keratitis, despite persisting moderate conjunctival hyperaemia. No adverse event associated with steroid use was observed during the treatment period and no problem in compliance was reported. Conclusion: Prednisone seems a better choice than intravenous corticosteroids, for treating moderate-to-severe and active Graves\u2019 ophthalmopathy, keeping in mind the importance of quality of life in pediatric patients.<\/jats:p>","DOI":"10.3390\/ijerph16010155","type":"journal-article","created":{"date-parts":[[2019,1,9]],"date-time":"2019-01-09T03:06:06Z","timestamp":1547003166000},"page":"155","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Corticosteroids in Moderate-To-Severe Graves\u2019 Ophthalmopathy: Oral or Intravenous Therapy?"],"prefix":"10.3390","volume":"16","author":[{"given":"Laura","family":"Penta","sequence":"first","affiliation":[{"name":"Paediatric Clinic, Department of Surgical and Biomedical Sciences, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Muzi","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Surgical and Biomedical Sciences, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Cofini","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Surgical and Biomedical Sciences, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Leonardi","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Surgical and Biomedical Sciences, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Lanciotti","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Surgical and Biomedical Sciences, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4103-2837","authenticated-orcid":false,"given":"Susanna","family":"Esposito","sequence":"additional","affiliation":[{"name":"Paediatric Clinic, Department of Surgical and Biomedical Sciences, Universit\u00e0 degli Studi di Perugia, 06129 Perugia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,1,8]]},"reference":[{"key":"ref_1","first-page":"1115","article-title":"An update on thyroid-associated ophthalmopathy in children and adolescents","volume":"29","year":"2016","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1530\/eje.1.01991","article-title":"Childhood Graves\u2019 ophthalmopathy: Results of a European questionnaire study","volume":"153","author":"Krassas","year":"2005","journal-title":"Eur. J. Endocrinol."},{"key":"ref_3","first-page":"234","article-title":"Pediatric aspects in Graves\u2019 orbitopathy","volume":"7","author":"Gogakos","year":"2010","journal-title":"Pediatr. Endocrinol. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e20171904","DOI":"10.1542\/peds.2017-1904","article-title":"Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical practice guideline for screening and management of high blood pressure in children and adolescents","volume":"140","author":"Flynn","year":"2017","journal-title":"Pediatrics"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1007\/BF03344156","article-title":"Cross sectional growth charts for height weight and BMI (2 ToYr)","volume":"29","author":"Cacciari","year":"2006","journal-title":"J. Endocrinol. Investig."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1530\/EJE-07-0666","article-title":"Consensus statement of the European Group on Graves\u2019 orbitopathy (EUGOGO) on management of GO","volume":"158","author":"Bartalena","year":"2008","journal-title":"Eur. J. Endocrinol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1016\/j.beem.2011.11.005","article-title":"Treatment of mild, moderate-to-severe and very severe Graves\u2019 orbitopathy","volume":"26","author":"Marcocci","year":"2012","journal-title":"Best Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1193","DOI":"10.1515\/JPEM.2006.19.10.1193","article-title":"Thyoid-associated ophthalmopathy in juvenile Graves\u2019 disease: Clinical, endocrine and therapeutic aspects; thyroid in childhood and adolescence","volume":"19","author":"Krassas","year":"2006","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1530\/eje.1.02230","article-title":"Clinical assessment of patients with Graves\u2019 orbitopathy: The European Group on Graves\u2019 orbitopathy recommendations to generalists, specialists and clinical researchers","volume":"155","author":"Wiersinga","year":"2006","journal-title":"Eur. J. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1046\/j.1365-2265.1997.2331047.x","article-title":"Clinical activity score as a guide in the management of patients with Graves\u2019 ophthalmopathy","volume":"47","author":"Mourits","year":"1997","journal-title":"Clin. Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wiersinga, W.M. (2010). Clinical manifestations. Graves\u2019 Orbitopathy. A Multidisciplinary Approach-Questions and Answers, Karger. [2nd, Revised Version].","DOI":"10.1159\/isbn.978-3-8055-9532-2"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"57","DOI":"10.2478\/v10153-010-0048-4","article-title":"Contemporary diagnostic and therapeutic abilities in childhood thyroid-associated ophthalmopathy with a clinical case description","volume":"52","author":"Kaleva","year":"2010","journal-title":"Folia Medica"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5234","DOI":"10.1210\/jc.2005-0148","article-title":"Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves\u2019 orbitopathy","volume":"90","author":"Kahaly","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_14","first-page":"3562","article-title":"Comparison of the effectiveness and tolerability of intravenous or oral glucocorticoids associated with orbital radiotherapy in the management of severe Graves\u2019 ophthalmopathy: Results of a prospective, single-blind, randomized study","volume":"86","author":"Marcocci","year":"2001","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1089\/jop.2005.21.328","article-title":"Early response to intravenous glucocorticoids for severe thyroid-associated ophthalmopathy predicts treatment outcome","volume":"21","author":"Hart","year":"2005","journal-title":"J. Ocul. Pharmacol. Ther."},{"key":"ref_16","first-page":"204","article-title":"Corticosteroids in the medical treatment of thyroid ophtalmopathy: When and how? Somatostatin analogues: Where we stand today","volume":"7","author":"Krassas","year":"2010","journal-title":"Pediatr. Endocrinol. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1089\/thy.2006.0267","article-title":"Determinants of liver damage associated with intravenous methylprednisolone pulse theraphy in Graves\u2019 ophtalmopathy","volume":"17","year":"2007","journal-title":"Thyroid"},{"key":"ref_18","first-page":"223","article-title":"Glucocorticoids in the medical management of Graves\u2019 ophthalmopathy","volume":"28","author":"Hart","year":"2003","journal-title":"Minerva Endocrinol."},{"key":"ref_19","first-page":"3767","article-title":"The management of Graves\u2019 disease in children, with special emphasis on radioiodine treatment","volume":"83","author":"Rivkees","year":"1998","journal-title":"J. Clin. Endocrinol. Metab."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/1\/155\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:24:17Z","timestamp":1760185457000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/1\/155"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,1,8]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,1]]}},"alternative-id":["ijerph16010155"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16010155","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2019,1,8]]}}}