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Graves’ Ophthalmopathy

  • Luigi BartalenaEmail author
Chapter

Abstract

Graves’ophthalmopathy (GO) is the main extrathyroidal manifestation of Graves’ disease. Its prevalence is declining lately, likely due to earlier diagnosis and management. Many patients with Graves’ disease have no ocular involvement; only 25% have GO, in most cases mild and often self-remitting, rarely progressing to more severe forms. Mild forms of GO can be treated by local measures (artificial eye drops, ocular gels) and by controlling risk factors for progression, mainly cigarette smoking and thyroid dysfunction. A 6-month course of selenium is useful in these mild forms, also in terms of prevention of GO progression. Moderate-to-severe and active forms are best treated with intravenous glucocorticoids, usually given as 12 weekly infusions, with a cumulative dose of methylprednisolone of 4.5–5 g. Higher doses can be used, not exceeding 8 g. Second-line treatments include orbital radiotherapy combined with either oral glucocorticoids or cyclosporine or rituximab. For the latter drug experience is limited and to some extent conflicting. Once GO is inactive, rehabilitative surgery is often needed for residual manifestations, including exophthalmos (treated by orbital decompression), eye muscle restriction with diplopia (treated by squint surgery), and eyelid malposition (treated by eyelid surgery).

Keywords

Graves’ disease Graves’ ophthalmopathy or orbitopathy TSH receptor Hyperthyroidism Thyroid autoimmune disease Thionamides Radioiodine Thyroidectomy Intravenous glucocorticoids Orbital radiotherapy 

Notes

Acknowledgments

This study was partly supported by grants from the Italian Ministry of Education, University and Research (MIUR, Rome; PRIN n. 2012Z3F7HE).

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Endocrine Unit, Department of Clinical and Experimental MedicineUniversity of InsubriaVareseItaly

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