Treatment of Graves' orbitopathy (ophthalmopathy)
- Terry F Davies, MD, FRCP, FACE
Terry F Davies, MD, FRCP, FACE
- Baumritter Professor of Medicine
- Mount Sinai School of Medicine
Graves' orbitopathy (ophthalmopathy, GO) is an autoimmune disease of the retroorbital tissues. This topic review will provide an overview of the treatment of this disorder; its pathogenesis and clinical features are discussed separately. (See "Pathogenesis and clinical features of Graves' ophthalmopathy (orbitopathy)".)
The natural history of Graves' orbitopathy is variable and must be considered in the context of concomitant antithyroid therapy. In some patients, as an example, orbitopathy changes little for many years. In others, it may worsen or improve, or, in a few patients, follow a course characterized by exacerbations and remissions. These variations make it especially difficult to reach conclusions about the efficacy of treatment .
One study, as an example, evaluated 59 patients with untreated eye disease who had not received any immunosuppressive or surgical treatment . They had all received an antithyroid drug, which may be immunosuppressive [3,4]. As assessed using a well-characterized activity index, 66 percent of these patients improved during the first 12 months, and only 8 percent had deterioration in their eye disease.
Treatment of patients with Graves' orbitopathy has three components:
●Reversal of hyperthyroidism, if present
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- NATURAL HISTORY
- ANTITHYROID TREATMENT
- Surgery or antithyroid drugs
- Radioiodine therapy
- SYMPTOMATIC TREATMENT
- Local measures
- MORE AGGRESSIVE THERAPY
- Glucocorticoid therapy
- External orbital radiation
- Other medical therapies
- - Somatostatin analogs
- Orbital decompression surgery
- - Timing of surgery
- Other operations
- SUGGESTED APPROACH TO THERAPY
- Mild symptoms
- Red eyes and progressive symptoms
- Loss of vision
- SUMMARY AND RECOMMENDATIONS