Abstract
The course and pathogenesis of Graves’ disease and Graves’ ophthalmopathy are interdependent,
influencing each other’s therapeutic choices. Multiple factors including geographic
location, access to medical services, patient and physician preferences influence
the management of these conditions. Graves’ disease is classically managed with one
of three treatment options – antithyroid drugs, radioactive iodine, and thyroidectomy.
In recent years, there has been a shift towards antithyroid drugs, including long
term therapy with these agents, given the advantage of avoiding hypothyroidism and
the apparent safety of this approach. In addition, new therapies are (slowly) emerging,
focusing on immunomodulation. Technological advances are opening doors to non-pharmaceutical
interventions that aim to deal with both structural thyroid abnormalities as well
as biochemical abnormalities of hyperthyroidism. Graves’ ophthalmopathy management
is guided by its activity and severity status, with treatment options including smoking
cessation, control of hyperthyroidism, local eye measures, glucocorticoids, selenium,
orbital radiotherapy, and surgery. In addition to these established treatment choices,
new immunotherapy-based approaches are being tested. Some of them (tocilizumab and
teprotumumab) are very promising but further evaluation is needed before we can establish
their role in clinical care. Agents identified as beneficial in Graves’ disease management
will likely be tested in Graves’ ophthalmopathy as well. In the coming years, our
main clinical responsibility will be to find the proper balance between the benefits
and potential risks of these incoming therapies, and to identify the subgroups of
patients where this ratio is most likely to favor a safe and successful therapeutic
outcome.
Key words
autoimmunity - thyroid function - hyperthyroidism - immunotherapy
