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Current concepts regarding Graves' orbitopathy.

Luigi Bartalena1, Maria Laura Tanda1

  • 1Department of Medicine and Surgery, University of Insubria, Varese, Italy.

Journal of Internal Medicine
|May 23, 2022
PubMed
Summary

Graves' orbitopathy (GO), an autoimmune eye disorder, often requires multidisciplinary management. While glucocorticoids are standard, emerging biological agents show promising results for moderate-to-severe cases.

Keywords:
Graves’ orbitopathyTSH receptorglucocorticoidsiscalimabrituximabteprotumumabthyrotropin receptortocilizumab

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Area of Science:

  • Ophthalmology and Endocrinology
  • Autoimmune and Endocrine Disorders

Background:

  • Graves' orbitopathy (GO) is an orbital autoimmune disorder and the primary extrathyroidal manifestation of Graves' disease.
  • It affects 30% of Graves' patients, with severe forms requiring immunosuppressive treatments in less than 10%.

Purpose of the Study:

  • To provide an updated overview of Graves' orbitopathy (GO) epidemiology, pathogenesis, assessment, and treatment.
  • To present emerging targeted therapies and future therapeutic perspectives for GO.

Main Methods:

  • Comprehensive literature search of original articles, clinical trials, systematic reviews, and meta-analyses from 1980 to 2021.
  • Keywords included Graves' disease, Graves' orbitopathy, thyroid eye disease, various treatments (glucocorticoids, radiotherapy, rituximab, etc.), and related conditions.

Main Results:

  • Recent studies indicate a trend toward a milder phenotype of GO.
  • Standardized assessment at a thyroid eye clinic improves management.
  • High-dose systemic glucocorticoids remain a primary treatment for active moderate-to-severe GO, alone or combined with other therapies.

Conclusions:

  • Novel biological agents like teprotumumab, rituximab, and tocilizumab have demonstrated encouraging efficacy in treating GO.
  • Further research into targeted therapies is crucial for improving outcomes in Graves' orbitopathy.