Current and Future Treatments for Graves’ Disease and Graves’ Ophthalmopathy

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.

Aktualne i nowe strategie leczenia aktywnej orbitopatii tarczycowej

“…Poprawę stanu okulistycznego obserwowano u 69-81% chorych leczonych metodą subtotalnej tyreoidektomii. Jednak ograniczona rola tej metody wynika z analizy jej efektywności w stosunku do kosztów oraz ryzyka możliwych powikłań, dlatego stosuje się ją przede wszystkim u pacjentów z bardzo dużym wolem położonym zamostkowo oraz u chorych, którzy nie odpowiedzieli na kilkukrotną terapię jodem promieniotwórczym [16].…”

“…Głównym wskazaniem do leczenia chirurgicznego jest kompresyjna neuropatia wzrokowa oraz ciężki wytrzeszcz z keratopatią. Wybór techniki chirurgicznej, poza preferencjami zespołu chirurgicznego, powinien mieć związek z indywidualnym obrazem klinicznym choroby [16]. W przypadku kompresyjnej neuropatii wzrokowej zalecaną przez wielu autorów metodą jest usunięcie dolnej i przyśrodkowej ściany oczodołu z wejścia przezprzedsionkowego.…”

Hormone and Metabolic Research: 50 Years of Research

“…Most recently, we also focused on thyroid diseases, e. g. autoimmune thyroid disease; here another three special issues were published highlighting the genetic cause as well as the immunological background, diagnostic procedures and therapeutic options in Graves' disease and autoimmune thyroiditis, including a most recent special issue [16][17][18][19][20][21][22][23][24].…”

Preclinical studies on the toxicology, pharmacokinetics and safety of K1-70TM a human monoclonal autoantibody to the TSH receptor with TSH antagonist activity

“…K1-70 ™ was isolated from the peripheral lymphocytes of a patient with a history of autoimmune thyroid disease and as such represents a "natural" inhibitor of TSHR stimulation [1][2][3]. The currently available options for the management of thyroid over activity in Graves' disease include anti-thyroid drugs, surgery or radioiodine ablation that are effective in the majority but not all of the patients [4][5][6]. Furthermore, there are limited specific therapies currently available for the management of Graves' ophthalmopathy [7][8][9].…”