The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy Guidelines for the Management of Graves’ Orbitopathy
Open accessAbstract
Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mechanisms of the disease. Treatment should rely on a thorough assessment of the activity and severity of GO and its impact on the patient's quality of life. Local measures (artificial tears, ointments and dark glasses) and control of risk factors for progression (smoking and thyroid dysfunction) are recommended for all patients. In mild GO, a watchful strategy is usually sufficient, but a 6-month course of selenium supplementation is effective in improving mild manifestations and preventing progression to more severe forms. High-dose glucocorticoids (GCs), preferably via the intravenous route, are the first line of treatment for moderate-to-severe and active GO. The optimal cumulative dose appears to be 4.5-5 g of methylprednisolone, but higher doses (up to 8 g) can be used for more severe forms. Shared decision-making is recommended for selecting second-line treatments, including a second course of intravenous GCs, oral GCs combined with orbital radiotherapy or cyclosporine, rituximab or watchful waiting. Rehabilitative treatment (orbital decompression surgery, squint surgery or eyelid surgery) is needed in the majority of patients when GO has been conservatively managed and inactivated by immunosuppressive treatment.
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There is no evidence suggesting that the clinical management of Graves' orbitopathy in post-IRT Graves' disease should be different from the spontaneous form.
“There is no evidence suggesting that the clinical management of GO in post-IRT GD should be different from the spontaneous form [90].”
From 2019 European Thyroid Association Guidelines on the Management of Thyroid Dysfunction following Immune Reconstitution Therapy (2019) · cites this paper as [90]
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Selenium in thyroid disorders—essential knowledge for clinicians
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Peiffert, M., Cugnet-Anceau, C., Dalle, S., Chikh, K., Assaad, S., Disse, E., Raverot, G., Borson-Chazot, F., & Abeillon-du Payrat, J. (2021) · Cancers · doi:10.3390/cancers13081944 · Cited by 33 · see citing works
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The influence of Graves’ orbitopathy treatment with intravenous glucocorticoids on adrenal function
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Pelewicz, K., Szewczyk, S., & Miśkiewicz, P. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9103233 · Cited by 9 · see citing works
- Authors
- Bartalena, L., Baldeschi, L., Boboridis, K., Eckstein, A., Kahaly, G. J., Marcocci, C., Perros, P., Salvi, M., & Wiersinga, W. M.
- Affiliations
- University of Insubria (IT)
- UCLouvain (BE)
- Aristotle University of Thessaloniki (GR)
- Essen University Hospital (DE)
- Johannes Gutenberg University Mainz (DE)
- University of Pisa (IT)
- Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
- University of Milan (IT)
- Amsterdam UMC Location University of Amsterdam (NL)
- ORCID
- Venue
- European Thyroid Journal
- Publisher
- Bioscientifica
- Published
- 2016-03-01
- Volume
- 5
- Issue
- 1
- Pages
- 9-26
- ISSN
- 2235-0640 (ISSN-L)
- 2235-0802
- PMC
- PMC4836120
- OpenAlex
- W2288910126
- Cited by
- 943
- References
- 129
- Citations by year
- 2026: 40 · 2025: 50 · 2024: 81 · 2023: 97 · 2022: 109 · 2021: 164 · 2020: 152 · 2019: 86 · 2018: 92 · 2017: 50 · 2016: 21 · 2015: 1
- FWCI
- 75.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- European Thyroid Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- IrInSubria (University of Insubria) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Neurology › Myasthenia Gravis and Thymoma
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Ocular Disorders and Treatments
- Keywords
- Graves' ophthalmopathy, Graves' disease, treatment guidelines, selenium supplementation, high-dose glucocorticoids, methylprednisolone, orbital radiotherapy, cyclosporine, rituximab, orbital decompression, squint surgery, eyelid surgery, shared decision-making, smoking, quality of life
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