Tear inflammatory cytokines and ocular surface changes in patients with active thyroid eye disease treated with high-dose intravenous glucocorticoids



To evaluate high-dose intravenous glucocorticoid treatment on tear inflammatory cytokines and ocular surface parameters in patients with active TED. Correlations between tear inflammatory cytokines and clinical parameters were also investigated.


This prospective pilot study included 15 moderate-to-severe and active TED patients. Control group consist of 15 sex and age-matched healthy subjects. All TED patients were treated with high-dose intravenous methylprednisolone with cumulative dose of 4.5 g during the therapy subdivided into 12 weekly infusions. Tear concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17A, tumor necrosis factor (TNF)-α, and vascular endothelial growth factor (VEGF) were measured by multiplex bead analysis in TED patients at baseline and 12 weeks after treatment. Ocular surface disease index (OSDI), tear break-up time (TBUT), corneal fluorescent staining, and Schirmer’s test were obtained from TED and controls.


All baseline cytokine levels except for IL-17A were significantly elevated in active TED patients compared with controls. Concentrations of IL-1β, IL-6, IL-8, TNF-α, and VEGF were significantly decreased at 12 weeks compared with baseline. OSDI and TBUT showed significant improvement at 6 and 12 weeks. There were significant positive correlations between IL-6, IL-8, and CAS, and negative correlation was found between IL-6 level and TED duration before methylprednisolone treatment. The reduction of IL-6, IL-8, and VEGF were positive correlated with the reduction in CAS at 12 weeks.


High-dose glucocorticoids treatment improved ocular surface symptom, increased the tear film stability, and decreased tear inflammatory cytokines in active TED. The reduction of the inflammatory cytokines is consistent with the improvement of clinical parameters.

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The authors thank Fayang Lian, a biostatistician from the Fujian Provincial Hospital, for giving us statistical consultation on this study.


This research was funded by the Fujian Provincial Natural Science Foundation (Grant Numbers 2018J01238; 2019J01152), the Joint Funds for the Innovation of Science and Technology of Fujian province (Grant Number 2018Y9035), the Startup Fund for Scientific Research of Fujian Medical University (Grant Number 2017XQ1022), and the Youth Foundation of Fujian Provincial Health Commission (Grant Number 2019-1-31).

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Conceptualization: NX and YC; Methodology: NX; Formal analysis and investigation: YC and DF; Writing—original draft preparation: NX; Writing—review and editing: YC and FS; Funding acquisition: NX and YC; Resources: YC, DF; Supervision: FS.

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Correspondence to F. Sun.

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Xu, N., Cui, Y., Fu, D. et al. Tear inflammatory cytokines and ocular surface changes in patients with active thyroid eye disease treated with high-dose intravenous glucocorticoids. J Endocrinol Invest 43, 901–910 (2020). https://doi.org/10.1007/s40618-019-01174-8

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  • Thyroid eye disease
  • Ocular surface
  • Cytokines
  • Tear