Thyroid-related orbitopathy: clinical overview, novel medical treatments and the role of orbital surgery

Abstract

Purpose: The aim of our review is to report the thyroid orbitopathy treatments, focusing on novel medicines and ongoing research.

Design: Review developed by a research group at Catholic University of the Sacred Heart.

Methods: Overview of the literature synthesizing the findings of literature retrieved from searches of computerized databases, hand searches and authoritative texts. Although minimally invasive surgical techniques have been developed, current research is placing greater emphasis on the use of biological and immunosuppressive drugs for the treatment of thyroid eye disease (TED). Teprotumumab, a monoclonal antibody targeting the insulin-like growth factor-1 receptor, has just been approved by the Food and Drug Administration as a therapy for the treatment of TED. This approval is based on its ability to relieve both the clinical signs and symptoms of the condition, such as proptosis and diplopia. Synthetic peptides imitating T cell epitopes and TSHR-CAR-T cells represent a potential and novel immunotherapeutic strategy.

Conclusions: The growth of several novel therapies highlights the intricate nature of the disease's aetiology and the multitude of processes involved in its regulation. These advancements reveal a future direction focused on personalized treatment of Graves' orbitopathy. The integration of multiple disciplines is becoming increasingly indispensable in the management of patients with this disease.

Keywords: Autoimmune disorder; Graves’ disease; Optic neuropathy; Orbital decompression; Orbital disease; Thyroid associated orbitopathy; Thyroid eye disease.