Medical Treatment of Graves’ Orbitopathy

Abstract

The medical treatment of Graves? orbitopathy (GO) is usually reserved to moderate to severe disease. Steroids have been widely employed and possess anti-inflammatory activity, but about 20?30% of patients are not responsive and about 20% present with disease recurrence. Immunosuppressive therapy alternative to corticosteroids may target the different antigens involved in pathogenic mechanisms of GO. Some have already been employed in clinical studies and showed interesting results, although the lack of randomized and controlled trials suggests caution for their use in clinical practice. Potential targets for therapy in GO are the TSH receptor and the IGF-1 receptor on the fibroblasts, inflammatory cytokines, B and T cells. Most promising results are obtained by interacting with the PIK3/mTORC1 signaling cascades for adipogenesis and the anti-IGF-1R with the monoclonal antibody teprotumumab. A recent open study has shown that tocilizumab, an anti-sIL-6R antibody, inactivates GO. Consistent reports on the efficacy of rituximab have recently been challenged by randomized controlled trials. Clinical practice will greatly benefit from the use of disease modifying agents in GO, as compared to steroids, currently standard treatment for GO. Among these, rituximab may be useful, especially in patients resistant to steroid or with contraindications to steroids. However, larger randomized controlled trials are needed for definitive data on the potential disease-modifying role of rituximab in GO. Direct targeting of the orbital fibroblast via immunosuppression or nonimmunosuppressive drugs is emerging as a promising alternative.

The thyroid, the eyes and the gut: a possible connection

“…The rationale for using RTX in GO is the potential blockade of pathogenic autoantibody generation and production of inflammatory cytokines or the depletion of B cells as antigen-presenting cells. Data recently published showed a significantly different efficacy maybe due to a different disease duration and severity of patients recruited, that means a different inflammatory pattern [48].…”

Combined immunosuppression and radiotherapy in thyroid eye disease (CIRTED): a multicentre, 2 × 2 factorial, double-blind, randomised controlled trial

“…The aim of treatment is to suppress orbital inflammation and reduce consequent tissue remodelling in extraocular muscles, orbital fat and other periocular soft tissues (4,5).…”

The Effects of Selenium Supplementation on Glucose Metabolism and Lipid Profiles Among Patients with Metabolic Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…While the classic essential nutrients have been widely evaluated, there is also great interest in selenium supplementation in relation to MetS. The beneficial effects of selenium on reducing CVD mortality [6], and maintenance of overall health, especially for the thyroid, immunity and homeostasis [7][8][9][10] have been previously reported. In a study by Wang et al [11], a positive association between selenium concentration and T2DM reported in people with relatively low and/or high selenium concentrations.…”