Active Thyroid Orbitopathy in a Colombian Population. Characteristics Associated With its Response to Steroids

Objective A significant proportion of patients with Graves’ orbitopathy do not respond adequately to treatment with glucocorticoids. Early identification of clinical factors associated with therapeutic response may help optimize management. The aim of this study is to characterize the population with active Graves’ orbitopathy and to compare the clinical features of patients who responded and those who did not respond to systemic glucocorticoid treatment. Methods A nested case-control study was conducted within a retrospective cohort of patients with moderate-to-severe or sight-threatening active Graves’ orbitopathy at a tertiary referral center. Adults with a Clinical Activity Score ≥ 3 and sufficient follow-up to assess response to therapy were included. Sociodemographic, clinical, ophthalmological, biochemical, and imaging variables were compared between responders and non-responders. Results Thirty-nine patients were analyzed, of whom 22 (56.4%) responded to first-line glucocorticoid treatment. Responders had a lower baseline Clinical Activity Score (mean 4.0 vs. 4.88; p=0.013), lower weight-adjusted cumulative steroid dose (median 58 vs. 74 mg/kg; p=0.030), and a lower frequency of keratopathy (57.1% vs. 88.2%; p=0.036). No significant differences were observed in thyroid profile, TSH receptor antibody levels, lipids, or tomographic findings. A trend toward higher smoking prevalence was observed among non-responders. Conclusions A lower baseline Clinical Activity Score , the absence of keratopathy, and lower cumulative steroid doses were associated with a better response to treatment. These findings suggest that ophthalmological and inflammatory markers may have greater clinical utility than conventional biochemical parameters.