Thyroid-associated orbitopathy is the most common extra-thyroid manifestation of Graves’ disease. It affects the orbital and peri-orbital tissues, leading to signs and symptoms such as eyelid edema, exophthalmos, and diplopia. The prevalence varies, affecting approximately 25 to 50% of patients with Graves’ disease. The pathogenesis of thyroid orbitopathy involves, among other factors, autoantibodies directed against TSH receptors present on orbital fibroblasts. Activation of these orbital fibroblasts results in the production of pro-inflammatory cytokines and glycosaminoglycans, causing inflammation and proliferation of orbital connective tissues, as well as adipogenesis. Treatments for orbitopathy in its active phase include general measures such as symptomatic ophthalmologic treatment (artificial tears, sun protection, headboard elevation), rapid and sustained restoration of euthyroidism, and smoking cessation. Depending on the severity, selenium is used for mild cases, while anti-inflammatory and immunosuppressive treatments are used for moderate to severe cases (sometimes with orbital radiotherapy). Decompression surgery is considered for forms that threaten visual prognosis. Despite recent therapeutic advances, the management of thyroid orbitopathy remains complex and requires a multidisciplinary approach. Future research is focused on understanding the underlying immune mechanisms and developing more targeted and effective treatments.
What is already known about the topic?
- Autoimmune disease mainly related to Graves’ disease
- Affects orbital tissues: exophthalmos, eyelid edema, and diplopia
- Autoantibodies stimulate inflammation via dimerization of TSH and IGF1 receptors.
- Major risk factor: smoking
- Treatments: antithyroid drugs, corticoids, radiotherapy, surgery, and immunomodulators
What does this article bring up for us?
- Overview of pathogenic mechanisms and risk factors
- Current therapeutic strategies
- Need for a multidisciplinary approach
- Research prospects for more targeted and effective treatments
Keywords
Orbitopathy, thyroid, Grave’s disease