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Graves orbitopathy: a perspective

Nature Reviews Endocrinology volume 5, pages 312–318 (2009)Cite this article

Abstract

Advances in the past few years have helped clinicians understand some of the pathogenetic mechanisms of Graves orbitopathy (GO), particularly the role of receptors for TSH and insulin-like growth factor I in the orbit. Optimal treatment strategies have been formulated and published by the European Group on Graves' Orbitopathy, which are hoped to improve the management of patients with this condition. The administration of intravenous pulses of steroids has been established as a superior treatment approach compared with other steroid regimens. In addition, orbital radiotherapy was effective in a subgroup of patients with GO who had eye dysmotility. The use of immunotherapies for the treatment of GO is currently being explored; of these, rituximab has emerged as a promising new agent.

Key Points

  • Graves orbitopathy is an autoimmune disease that is closely associated with Graves disease

  • Smoking, hypothyroidism and radioiodine therapy can exacerbate Graves orbitopathy

  • Immunosuppressive therapy is only effective during the initial, active phase of the disease

  • High doses of steroids administered as intravenous pulses are more effective and associated with fewer adverse effects than orally administered steroids

  • Surgical decompression of the orbit has a major role in management of patients with Graves orbitopathy complicated by optic neuropathy who fail to respond to medical treatment

  • Rehabilitative, reconstructive surgery used in the inactive phase of the disease has an important role in restoration of the function and appearance of the eye

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Figure 1: Schematic drawing showing mechanical changes in the orbit in Graves orbitopathy.
Figure 2: MRI/CT scans through the orbits of patients with Graves orbitopathy.

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Author information

Authors and Affiliations

  1. Endocrine Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK

    Petros Perros

  2. Department of Endocrinology, Diabetes and Metabolism, Panagia General Hospital, Thessaloniki, Greece

    Gerasimos E. Krassas

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  2. Gerasimos E. Krassas
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Correspondence to Petros Perros.

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Perros, P., Krassas, G. Graves orbitopathy: a perspective. Nat Rev Endocrinol 5, 312–318 (2009). https://doi.org/10.1038/nrendo.2009.61

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