Recent advances in graves ophthalmopathy medical therapy: a comprehensive literature review

Abstract

Graves ophthalmopathy (GO), which occurs in autoimmune thyroid disease, can reduce patients' quality of life due to its impact on visual function, physical appearance, and emotional health. Corticosteroids have been the first-line treatment for GO. More recently, the pathogenesis of GO has made significant progress. Various targeting biological agents and immunosuppressive agents make GO management more promising. Fully understanding GO pathogenesis and precise clinical management are beneficial for the prognosis of patients. Therefore, we conducted a comprehensive review of the medical management of GO and summarized research developments to highlight future research issues.

Keywords: Diagnosis; Graves ophthalmopathy; Management; Thyroid-associated ophthalmopathy.

Fig. 1

Graves Ophthalmopathy pathogenesis. Autoreactive T cells interact with orbital fibroblasts (OFs) via CD40:CD154 ligation. B cells differentiate into plasma cells, which synthesize and secrete TRAb. TRAb can mediate the autoimmune response of GO by recognizing TSHR. Activated OFs then secrete various inflammatory cytokines. TSHR and IGF-1R are expressed in the common area of the OFs membrane and exist in the form of a complex which plays a synergistic role in the functional regulation of orbital fibroblasts. Activated OFs can differentiate into either myofibroblasts or adipocytes and promote hyaluronan synthesis. As a result, orbital soft tissue expansion and congestion in GO. Created with BioRender.com