Recent advances in the management of thyroid associated orbitopathy: A promising roadmap

Thyroid associated orbitopathy (or Graves' orbitopathy) is the most common extrathyroidal manifestation of Graves' disease; an auto-immune entity that has precarious visual consequences as well as psychological morbidity even in its milder stages. The treatment is largely based on the 'activity' and 'severity' of the disease; however, outcome can vary between patients depending on certain known and unknown risk factors. While there are certain guidelines on managing the orbitopathy, there are multiple lacunae in our knowledge of its pathophysiology. The current era is one where our mainstay of treatment of the active disease is still glucocorticoids, albeit a few good immunomodulatory drugs that have shown promising outcomes are in our armamentarium. In this article we present a compendium of the current consensus in the management of Graves' orbitopathy, its evidence based rationale and crucial constraints along with the details of emerging biological agents.