Abstract
Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.
| Original language | English |
|---|---|
| Pages (from-to) | 9-26 |
| Number of pages | 18 |
| Journal | European Thyroid Journal |
| Volume | 5 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Mar 1 2016 |
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Keywords
- Cyclosporine
- Eyelid surgery
- Glucocorticoids
- Graves' orbitopathy
- Orbital decompression
- Orbital radiotherapy
- Rituximab
- Selenium
- Squint surgery
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism
Cite this
The 2016 European Thyroid Association/European Group on Graves' orbitopathy guidelines for the management of graves' orbitopathy. / Bartalena, Luigi; Baldeschi, Lelio; Boboridis, Kostas; Eckstein, Anja; Kahaly, George J.; Marcocci, Claudio; Perros, Petros; Salvi, Mario; Wiersinga, Wilmar M.
In: European Thyroid Journal, Vol. 5, No. 1, 01.03.2016, p. 9-26.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The 2016 European Thyroid Association/European Group on Graves' orbitopathy guidelines for the management of graves' orbitopathy
AU - Bartalena, Luigi
AU - Baldeschi, Lelio
AU - Boboridis, Kostas
AU - Eckstein, Anja
AU - Kahaly, George J.
AU - Marcocci, Claudio
AU - Perros, Petros
AU - Salvi, Mario
AU - Wiersinga, Wilmar M.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.
AB - Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.
KW - Cyclosporine
KW - Eyelid surgery
KW - Glucocorticoids
KW - Graves' orbitopathy
KW - Orbital decompression
KW - Orbital radiotherapy
KW - Rituximab
KW - Selenium
KW - Squint surgery
UR - http://www.scopus.com/inward/record.url?scp=84985017669&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84985017669&partnerID=8YFLogxK
U2 - 10.1159/000443828
DO - 10.1159/000443828
M3 - Article
VL - 5
SP - 9
EP - 26
JO - European Thyroid Journal
JF - European Thyroid Journal
SN - 2235-0640
IS - 1
ER -