×
Choose Speciality

EXPLORE!

LOGIN

Management of Graves Orbitopathy: An Update

  949 Views

Dr Wilmar M Wiersinga, Netherlands    21 November 2018

  1. In a study conducted to construct a predictive score for the development or progression of Graves orbitopathy (GO) in Graves hyperthyroidism (GH), among patients without GO at diagnosis, 15% developed GO (13% mild, 2% moderate-to-severe) during subsequent treatment with ATD. Independent baseline determinants for the development of GO included clinical activity score, TSH-binding inhibitory immunoglobulins, duration of hyperthyroid symptoms and smoking.
  2. A recent study compared the efficacy and safety of add-on mycophenolate to methylprednisolone in comparison with methylprednisolone alone in patients with moderate-to-severe GO. While there were no significant differences in the rate of response at 12 weeks or rate of relapse at 24 and 36 weeks, post-hoc analysis suggested that addition of mycophenolate improved rate of response to therapy by 24 weeks in patients with active and moderate-to-severe GO (Kahaly et al. Lancet Diab Endocrinol. 2018;6(4):287-98).
  3. Selenium is known to improve mild GO and prevents deterioration of mild GO. Promising new therapies in active moderate-to-severe GO include rituximab, teprotumumab and tocilizumab. But, IV steroids remain the treatment of choice until RCTs comparing steroids with these novel agents show greater efficacy and better tolerability. It is too early to dismiss rituximab as a disease-modifying drug and too early to accept it as an alternative to IV methylprednisolone. Therefore, rituximab currently has a role in resistant cases, not responding to steroids.

To comment on this article,
create a free account.

Sign Up to instantly get access to 10000+ Articles & 1000+ Cases

Already registered?

Login Now

Most Popular Articles

News and Updates

eMediNexus provides latest updates on medical news, medical case studies from India. In-depth medical case studies and research designed for doctors and healthcare professionals.