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Perbandingan Efektifitas Metilprednisolon Intravena dengan Oral pada Kasus Grave Ophthalmopathy di RSUP Dr M Djamil Padang Efendi, Mardijas; Hendriati, Hendriati; Primasakti, Pattih; Erwen, Yolanda Wulandari
Jurnal Kesehatan Andalas Vol. 14 No. 1 (2025): March 2025
Publisher : Faculty of Medicine, Universitas Andalas

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Grave's Ophthalmopathy can occur in three phases depending on the inflammatory process. Immunosuppressant therapy is an anti-inflammatory option for managing the active phase of GO. A study showed a significant improvement in GO proptosis in patients treated with methylprednisolone. Objective: To determined the frequency of proptosis in Thyroid Eye Disease (TED) patients and the differential effect of oral or intravenous steroid administration. Methods: This study was a prospective cohort study through medical record data from March 2023 to March 2024. The subjects are all inpatients with thyroid eye disease in Dr M Djamil General Hospital, Padang. T-tests were performed to determine each group's different perceptions. Results: Thirty-six subjects with Grave’s ophthalmopathy. The effect size of the changes in Hertel values in patients given both oral and intravenous corticosteroid therapy is significant in both eyes. The effect size of the oral therapy is significant, with 0.341 in the right eyes and 0.303 in the left eyes. The intravenous therapy is also significant, with the effect size 0.347 in the right and 0.271 in the left. The change of Hertel value in patients given both oral and intravenous corticosteroid therapy is significant in the right eyes (p = 0.009 and p = 0.008). Conclusion: Oral and injectable corticosteroids have similar effectiveness, thus providing flexibility in therapy selection for patients with thyroid eye disease. Keywords: Grave ophthalmopathy, intravenous methylprednisolone, oral methylprednisolone

Balancing Efficacy and Tolerability: A Prospective Cohort Study of Oral and Intravenous Methylprednisolone for Active Graves' Ophthalmopathy in an Indonesian Tertiary Care Center Mardijas Efendi; Hendriati; Pattih Primasakti; Yolanda Wulandari Erwen
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1466

Background: In managing active, moderate-to-severe Graves' Ophthalmopathy (GO), a notable gap often exists between treatment efficacy in controlled trials and effectiveness in real-world practice. High-dose corticosteroids are standard, but the choice between intravenous (IV) and oral routes involves a complex trade-off between efficacy, tolerability, and practicality, particularly in diverse populations. Methods: This single-center, pragmatic, prospective cohort study was conducted at a tertiary hospital in Indonesia from March 2023 to March 2024. Thirty-six GO patients were treated with either IV pulse or daily oral methylprednisolone based on a shared clinical decision-making process. The primary outcome was the change in proptosis. To address the non-randomized design and control for selection bias, a propensity score-adjusted Analysis of Covariance (ANCOVA) was used to compare treatment effectiveness. Results: Baseline analysis revealed that patients selected for IV therapy had significantly more severe proptosis. Both unadjusted and adjusted analyses showed that each regimen resulted in a significant reduction in proptosis from baseline (p < 0.01). In the primary, propensity score-adjusted analysis, no statistically significant difference was detected in the degree of proptosis reduction between the IV and oral groups. However, the tolerability profiles were profoundly different; patients in the oral group experienced a significantly higher incidence of adverse events, including dyspepsia (66.7%) and Cushingoid features (55.6%), compared to a single case of transient hypokalemia in the IV group. Conclusion: In this real-world setting, after statistically controlling for baseline severity, both IV and oral methylprednisolone demonstrated comparable effectiveness in reducing proptosis. However, the intravenous route was associated with a vastly superior safety profile. These findings underscore the critical importance of tolerability in clinical decision-making and support the continued recommendation of IV pulse therapy as the first-line treatment.

Balancing Efficacy and Tolerability: A Prospective Cohort Study of Oral and Intravenous Methylprednisolone for Active Graves' Ophthalmopathy in an Indonesian Tertiary Care Center Mardijas Efendi; Hendriati; Pattih Primasakti; Yolanda Wulandari Erwen
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1466

Background: In managing active, moderate-to-severe Graves' Ophthalmopathy (GO), a notable gap often exists between treatment efficacy in controlled trials and effectiveness in real-world practice. High-dose corticosteroids are standard, but the choice between intravenous (IV) and oral routes involves a complex trade-off between efficacy, tolerability, and practicality, particularly in diverse populations. Methods: This single-center, pragmatic, prospective cohort study was conducted at a tertiary hospital in Indonesia from March 2023 to March 2024. Thirty-six GO patients were treated with either IV pulse or daily oral methylprednisolone based on a shared clinical decision-making process. The primary outcome was the change in proptosis. To address the non-randomized design and control for selection bias, a propensity score-adjusted Analysis of Covariance (ANCOVA) was used to compare treatment effectiveness. Results: Baseline analysis revealed that patients selected for IV therapy had significantly more severe proptosis. Both unadjusted and adjusted analyses showed that each regimen resulted in a significant reduction in proptosis from baseline (p < 0.01). In the primary, propensity score-adjusted analysis, no statistically significant difference was detected in the degree of proptosis reduction between the IV and oral groups. However, the tolerability profiles were profoundly different; patients in the oral group experienced a significantly higher incidence of adverse events, including dyspepsia (66.7%) and Cushingoid features (55.6%), compared to a single case of transient hypokalemia in the IV group. Conclusion: In this real-world setting, after statistically controlling for baseline severity, both IV and oral methylprednisolone demonstrated comparable effectiveness in reducing proptosis. However, the intravenous route was associated with a vastly superior safety profile. These findings underscore the critical importance of tolerability in clinical decision-making and support the continued recommendation of IV pulse therapy as the first-line treatment.

The Profile of Sinonasal Tumors with Orbital Involvement in Dr. M. Djamil General Hospital, Padang, Indonesia: A 10-Year Overview Pohan, Dwi Lestari; Ardizal Rahman; Mardijas Efendi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 6 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i6.1014

Background: Sinonasal tumors are rare tumors, either malignant or benign, that vary greatly based on the origin and primary tumor location in the sinonasal tract. The close anatomical relationship between the sinonasal tract and the orbital cavity makes orbital involvement very common (50%-80%) in sinonasal tumors, and this indicates a negative prognostic factor in sinonasal malignancy. The purpose of this study is to demonstrate the profile of sinonasal tumors with orbital involvement in our center. Methods: Retrospective study from oncology subdivision files and medical records from January 2011 – December 2020. Collected data including age, gender, the clinical manifestations of orbital involvement, primary location, histopathology, and management of sinonasal tumors. Results: There were 35 patients examined by the oncology subdivision either directly came or consulted from the ENT department, consisting of 18 (51.4%) males and 17 (48.6%) females. The age of patients ranged from 11 to 83 years old. with the most common age groups being 41-50 and 51-60 (25.7% in each age group). The majority of the patients (77.1%) had presented with proptosis. Maxillary sinus was the most common (45.7%) primary site of tumors, and squamous cell carcinoma was the most common (51.4%) histopathology found. Most of the patients (37.1%) were treated with a combination of chemotherapy and radiotherapy. Conclusion: Orbital involvement commonly occurs in malignant sinonasal tumors with proptosis as a major clinical presentation. A combination of chemotherapy and radiotherapy was the most common practice management because the tumors were unresectable at the time of presentation.

Atypical Presentation of Clinically Non-Functioning Pituitary Macroadenoma: Case Report of Concurrent Graves' Disease and Multi-Axis Pituitary Hypofunction in a 40-Year-Old Female Rizkha Amaliya; Dolly Irfandy; Hesty Lidya Ningsih; Alexander Kam; Mardijas Efendi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1610

Background: Non-functioning pituitary adenomas (NFPAs) present variable clinical manifestations depending on tumor size and location. Concurrent primary autoimmune thyroid disease in NFPA patients is exceptionally rare and requires careful diagnostic distinction from secondary hypothyroidism. Case presentation: A 40-year-old female presented with progressive bilateral peripheral vision narrowing over 3 months, chronic bifrontal headaches, secondary amenorrhea, and nocturia-predominant polyuria. Neuro-ophthalmologic examination revealed bitemporal hemianopsia with visual acuity 20/200 left eye and 20/25 right eye. Endocrine evaluation demonstrated: primary hyperthyroidism (TSH 0.02 µIU/mL, FT4 28.32 pmol/L, positive thyroid receptor antibodies), secondary adrenal insufficiency (cortisol 1 µg/dL, ACTH <5 pg/mL), and hypogonadotropic hypogonadism (LH 1.62 IU/L). Neuroimaging revealed a 2.13 × 2.28 × 3.05 cm sellar/suprasellar lesion with optic chiasm compression (Knosp Grade II). Endoscopic transsphenoidal surgery achieved complete gross total resection. Histopathology confirmed null-cell adenoma with low Ki-67 proliferation index (2%). Conclusion: Postoperative course was uncomplicated with rapid visual field improvement, complete resolution of bitemporal hemianopsia by 2 weeks, and normalization of all endocrine axes by 12 weeks, including menstrual recovery and gonadal axis restoration. This case illustrates the diagnostic challenge of distinguishing secondary hyperprolactinemia from primary prolactinoma in NFPA, the rarity of concurrent Graves' disease with pituitary macroadenoma, and favorable outcomes with complete surgical decompression achieving multisystem endocrine recovery.

Atypical Presentation of Clinically Non-Functioning Pituitary Macroadenoma: Case Report of Concurrent Graves' Disease and Multi-Axis Pituitary Hypofunction in a 40-Year-Old Female Rizkha Amaliya; Dolly Irfandy; Hesty Lidya Ningsih; Alexander Kam; Mardijas Efendi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 6 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i6.1610

Background: Non-functioning pituitary adenomas (NFPAs) present variable clinical manifestations depending on tumor size and location. Concurrent primary autoimmune thyroid disease in NFPA patients is exceptionally rare and requires careful diagnostic distinction from secondary hypothyroidism. Case presentation: A 40-year-old female presented with progressive bilateral peripheral vision narrowing over 3 months, chronic bifrontal headaches, secondary amenorrhea, and nocturia-predominant polyuria. Neuro-ophthalmologic examination revealed bitemporal hemianopsia with visual acuity 20/200 left eye and 20/25 right eye. Endocrine evaluation demonstrated: primary hyperthyroidism (TSH 0.02 µIU/mL, FT4 28.32 pmol/L, positive thyroid receptor antibodies), secondary adrenal insufficiency (cortisol 1 µg/dL, ACTH <5 pg/mL), and hypogonadotropic hypogonadism (LH 1.62 IU/L). Neuroimaging revealed a 2.13 × 2.28 × 3.05 cm sellar/suprasellar lesion with optic chiasm compression (Knosp Grade II). Endoscopic transsphenoidal surgery achieved complete gross total resection. Histopathology confirmed null-cell adenoma with low Ki-67 proliferation index (2%). Conclusion: Postoperative course was uncomplicated with rapid visual field improvement, complete resolution of bitemporal hemianopsia by 2 weeks, and normalization of all endocrine axes by 12 weeks, including menstrual recovery and gonadal axis restoration. This case illustrates the diagnostic challenge of distinguishing secondary hyperprolactinemia from primary prolactinoma in NFPA, the rarity of concurrent Graves' disease with pituitary macroadenoma, and favorable outcomes with complete surgical decompression achieving multisystem endocrine recovery.

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