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Current Knowledge on Graves' Orbitopathy.

Katarzyna Gontarz-Nowak1, Magdalena Szychlińska1, Wojciech Matuszewski1

  • 1Clinic of Endocrinology, Diabetology and Internal Medicine, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, 10-957 Olsztyn, Poland.

Journal of Clinical Medicine
|December 30, 2020
PubMed
Summary

Graves' orbitopathy (GO) management is complex, often requiring multidisciplinary care. While current treatments like glucocorticoids and radiotherapy exist, new therapies like Teprotumumab offer future promise for active GO.

Keywords:
Graves’ diseaseGraves’ orbitopathyclinical activity scoreglucocorticoidsimmunosuppressive treatmentradiotherapy

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Area of Science:

  • Ophthalmology
  • Endocrinology
  • Immunology

Background:

  • Graves' orbitopathy (GO) is an autoimmune orbital inflammation, a common extrathyroidal manifestation of Graves' disease (GD).
  • Mild GO cases are frequently misdiagnosed, delaying treatment and potentially leading to severe outcomes, including vision loss.
  • Understanding GO's pathogenesis is crucial for effective diagnosis and management.

Purpose of the Study:

  • To review the etiopathogenesis, diagnostics, and current/future therapeutic options for Graves' orbitopathy.
  • To analyze the challenges and advancements in managing active and chronic GO.
  • To highlight the need for interdisciplinary collaboration and further research.

Main Methods:

  • Comprehensive literature review of Graves' orbitopathy.
  • Analysis of current treatment strategies, including medical and surgical interventions.
  • Evaluation of emerging therapies and their potential efficacy.

Main Results:

  • Current active GO treatment involves intravenous glucocorticoids and orbital radiotherapy.
  • Immunosuppressants and monoclonal antibodies show potential but are not effective in fibrotic stages.
  • Surgical interventions are necessary for chronic, fibrotic GO, including decompression and muscle/eyelid procedures.

Conclusions:

  • GO management is challenging, necessitating interdisciplinary collaboration among endocrinology, ophthalmology, radiation oncology, and surgery.
  • Limited study heterogeneity hinders reliable efficacy and safety comparisons of current therapies.
  • Teprotumumab's FDA approval marks a potential milestone, but further clinical investigation is essential.