April - June 2014, Volume 10, Issue 2

Bartalena L

What is the Role of Medical Therapy in the Management of Graves’ Orbitopathy?

Acta Endo (Buc) 2014, 10 (2): 249-258
doi: 10.4183/aeb.2014.249

Most patients with Graves’ disease have no or mild and non-progressive Graves’ orbitopathy (GO). Moderate-to-severe and active GO is rare, but represents a therapeutic challenge. Currently available treatments are often associated with unsatisfactory results because they do not target specifically pathogenetic mechanisms. Many patients need some kind of rehabilitative surgery at the end of the story. On a pessimistic view, it might be said that in many instances the role of non-surgical treatments (high-dose glucocorticoids, orbital radiotherapy) is limited to accelerate inactivation of GO and allow rehabilitative surgery at an earlier stage. Experts in this field are working on optimizing old treatments, but we cannot reasonably expect substantial improvements with respect to treatment outcomes reported in the literature using the same therapies. Novel treatments targeting pathogenetic mechanisms of the disease, such as rituximab, monoclonals or small peptides blocking the TSH receptor, monoclonals blocking the IGF-1 receptor, monoclonals inhibiting cytokines, might represent a novel and more effective approach for the management of this disease. We are, however, far away from translating promising results of basic research into clinical practice.

Keywords: Graves’ orbitopathy, Glucocorticoids, Orbital Radiotherapy, Rituximab, Orbital Decompression.

Correspondence: Luigi Bartalena MD, University of Insubria, Endocrine Unit, Ospedale di Circolo, Department of Clinical and Experimental Medicine, Viale Borri, 57, 21100 Varese, Italy, E-mail: luigi.bartalena@uninsubria.it