New insights into pathogenesis and potential therapeutic options for Graves orbitopathy

Graves disease is an autoimmune disorder that affects the seemingly heterogeneous tissues of the thyroid and orbit. Evidence suggests that these tissues share a common antigen: the thyroid-stimulating hormone receptor protein. It is speculated that this antigen (which is present in orbital tissue in both normal patients and patients with Graves disease), together with the humoral factors present in the serum of patients with Graves disease, forms the basis for the immunologic attack seen in Graves ophthalmopathy. Once the immune response has been activated, a series of pro-inflammatory cytokines propagate inflammation, leading to the clinical findings typical of Graves ophthalmopathy. Knowledge of the specific inflammatory mediators involved may someday lead to the development of specific, clinically available immunomodulatory therapies for Graves eye disease.