Update on the medical treatment of Graves' ophthalmopathy

Abstract

Purpose: To review recent advances in the understanding of Graves' ophthalmopathy (GO) pathogenesis as well as discuss current and future medical management strategies.

Design: Interpretive essay.

Methods: Literature review and interpretation.

Results: Medical treatment of GO has slowly evolved during the past few decades and has been hampered by a poor understanding of the disease at a cellular and molecular level. Current treatment recommendations and guidelines therefore focus on nonspecific immuno-suppression. Newer classes of treatment agents hold promise to more selectively target underlying cellular and molecular alterations in GO.

Conclusion: Cooperation between individual patients, physicians and between differing medical centers, together with a refined understanding of the pathogenesis of GO, will lead to newer more-effective treatments for the disease and improve patient quality of life.

Keywords: Graves’ ophthalmopathy; thyroid eye disease; thyroid-associated ophthalmopathy.

Figure 1

Axial CT scan of orbits, 67-year-old woman with Graves’ ophthalmopathy with proptosis secondary to extraocular muscle expansion. Arrows demonstrate enlarged medial rectus muscles. Also note that left lateral rectus muscle is also enlarged.

Figure 2

Proposed targets for agents of potential benefit in the treatment of Graves’ ophthalmopathy. 1) blocking T-cell co-stimulation, 2) depleting B cells, 3) inhibiting cytokine action, 4) targeting the insulin-growth factor 1 (IGF-1) receptor or the thyrotropin (TSH) receptor, and 5) preventing connective tissue remodeling. Adapted with permission from Garrity JA, Bahn RS. Pathogenesis of Graves Ophthalmopathy: Implications for Prediction, Prevention, and Treatment. Am J Ophthalmol. 2006;142(1):147–153. Copyright © 2008 Elsevier.