Objective：To evaluate the value of serum lipid metabolism and orbital magnetic resonance imaging（MRI）quantitative parameters in predicting the efficacy of glucocorticoid（GC）therapy in patients with active and moderate -to-severe thyroid-associated ophthalmopathy（TAO）. Methods：The study retrospectively enrolled 44 patients with active and moderate-to-severe TAO receiving GC therapy，according to GC efficacy，patients were divided into the GC-sensitive group（n=28）and the GC -insensitive group（n=16）. Serum lipid metabolism，orbital MRI-based lacrimal gland herniation/orbital fat thickness（LGH/OFT）as well as other clinical parameters before GC therapy were collected and compared between the two groups. Multivariate logistic regression and receiver operating characteristic curve were used to analyze the independent predictors related to GC therapy efficacy and evaluate their predictive value. Results：The serum total cholesterol and serum low-density lipoprotein cholesterol in GC-sensitive group were significantly lower than those in the insensitive group（P=0.005，P=0.019），and the disease duration was shorter in the sensitive group （P=0.037）. The ratio of LGH/OFT in the sensitive group was higher than that in the insensitive group significantly（P ＜ 0.001）. Serum total cholesterol and LGH/OFT were found to be independent predictors of sensitivity to GC therapy in TAO patients through multivariate analysis（odds ratio were 0.230 and 1.395_{per 0.1 units}，respectively）（both P ＜ 0.05）. Combining serum total cholesterol ≤ 4.8 mmol/L and LGH/OFT ≥ 1.51，the best predictive efficacy could be obtained（area under the curve 0.838，sensitivity 87.5%， specificity 65.6%）. Conclusion：Both serological lipid parameters and orbital MRI quantitative parameters can predict the sensitivity of GC therapy in patients with active and moderate-to-severe TAO，and their combinations can further improve the predictive performance.