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Treatment of Graves' orbitopathy (ophthalmopathy)

Terry F Davies, MD, FRCP, FACE
Section Editor
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD


Graves' orbitopathy (ophthalmopathy) is an autoimmune disease of the retro-orbital 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 hyperthyroidism therapy [1-3]. (See 'Direct effect of type of therapy' below.)

In some patients, 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. (See 'Efficacy' below.)

One study, as an example, evaluated 237 patients with newly diagnosed Graves' hyperthyroidism who were treated with thionamides [1]. At initial presentation, the majority (73.7 percent) of patients had no ocular involvement, whereas mild, moderate-to-severe, and sight-threatening orbitopathy were present in 20, 5.8, and 0.3 percent of patients, respectively. During the 18-month follow-up period, progression to moderate-to-severe orbitopathy occurred in 2.6 percent of patients with no orbitopathy at baseline and in 2.4 percent of patients with mild activity at baseline. In contrast, 58 percent of patients with mild disease at baseline experienced complete remission.


Treatment of patients with Graves' orbitopathy includes:

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Literature review current through: Nov 2017. | This topic last updated: Oct 14, 2016.
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