[Thyroid associated orbitopathy: from diagnosis to treatment]

Area of Science:

• Endocrinology
• Ophthalmology
• Autoimmune Diseases

Context:

• Thyroid orbitopathy (TO) is an autoimmune condition affecting the eye socket, frequently associated with autoimmune thyroid disease.
• While mild to moderate TO is common, severe presentations are rare but can lead to significant morbidity.
• Management requires a multi-faceted approach addressing thyroid status, lifestyle factors, and specific eye symptoms.

Purpose:

• To outline current management strategies for thyroid orbitopathy based on disease severity and activity.
• To highlight the role of selenium in mild TO and intravenous steroids in active disease.
• To define indications for surgical intervention in refractory or chronic TO.

Summary:

• Euthyroidism restoration, smoking cessation, and ocular lubricants are foundational for all patients with TO.
• Selenium supplementation is indicated for mild TO, while active or moderate-to-severe TO benefits from intravenous corticosteroids.
• Surgical options are reserved for cases of steroid-resistant optic neuropathy or significant sequelae.

Impact:

• Provides a clear treatment algorithm for clinicians managing thyroid orbitopathy.
• Emphasizes evidence-based therapeutic options, including newer indications for selenium.
• Aims to improve patient outcomes by optimizing treatment based on disease phenotype.