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Generation of a Mouse Spontaneous Autoimmune Thyroiditis Model
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Understanding Pathogenesis Intersects With Effective Treatment for Thyroid Eye Disease.

Terry J Smith1

  • 1Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.

The Journal of Clinical Endocrinology and Metabolism
|November 8, 2022
PubMed
Summary

Recent advances offer improved treatments for thyroid eye disease (TED), an autoimmune condition. New therapies like teprotumumab, rituximab, and tocilizumab show promise, potentially replacing steroids as first-line treatment for TED.

Keywords:
Graves’ diseaseIGF-I receptorIL-6 receptorTSH receptorautoimmunityglucocorticoidsophthalmopathyorbitteprotumumab

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Area of Science:

  • Ophthalmology
  • Endocrinology
  • Immunology

Background:

  • Thyroid eye disease (TED) is a vision-threatening autoimmune condition with limited effective treatments.
  • Current therapies, including glucocorticoids, often fail to fully address key symptoms like proptosis and diplopia.

Purpose of the Study:

  • To review historical and recent scientific advances in understanding the pathogenesis of TED.
  • To evaluate current and emerging treatment options for TED.

Main Methods:

  • A literature search of PubMed was conducted using terms such as thyroid-associated ophthalmopathy, Graves' orbitopathy, and orbital inflammation.
  • The review assessed the strength of evidence, scope, and controls of clinical trials and observations.

Main Results:

  • Glucocorticoids are common but have limitations in treating proptosis and diplopia.
  • Emerging therapies include mycophenolate, rituximab, tocilizumab, and teprotumumab, targeting various inflammatory and molecular pathways.
  • Novel approaches focus on prostaglandin receptors, VEGF, mTOR, and cholesterol pathways, with immune tolerance restoration as a long-term goal.

Conclusions:

  • Steroids may be superseded by more effective and better-tolerated treatments for TED.
  • Teprotumumab, rituximab, and tocilizumab represent promising current and emerging therapeutic options.
  • Restoring immune tolerance holds potential as the most effective and safe long-term management strategy for TED.