[Management of Graves' orbitopathy: evidence-based recommendations]

Abstract

Patients with Graves' orbitopathy (GO) suffer from disfiguring proptosis, orbital pain and diplopia. Compression of the optic nerve may cause functional restrictions to the point of loss of vision. Since suboptimal management of GO seems to be widespread, the European Group On Graves' Orbitopathy (EUGOGO) provided a consensus statement on the management of GO. According to EUGOGO, patients with GO should be referred to multidisciplinary specialist centers. All patients should be encouraged to quit smoking. Prompt treatment of thyroid dysfunction is mandatory in order to restore and maintain euthyroidism. The first-line treatment for optic neuropathy and/or corneal ulceration are intravenous glucocorticoids. If the response is poor after 1-2 weeks, orbital decompression surgery should follow. Intravenous glucocorticoids are also recommended in patients with moderate-to-severe and active GO. If GO is inactive, surgery should be considered. Local measures and an expectant strategy are sufficient in most patients with mild GO, but if quality of life is affected significantly, specific treatment may be justified. Thus, management of GO remains challenging and is best performed within a multidisciplinary orbital center.