Recent advances in thyroid orbitopathy treatment: A narrative review

• Ankita Jaiswal*

Abstract

Thyroid-associated orbitopathy (TAO), the most common extrathyroidal manifestation of Graves' disease, is marked by orbital inflammatory infiltration and activation of orbital fibroblasts. Key interactions among T cells, B cells, and orbital fibroblasts perpetuate inflammation and tissue remodeling. Particularly, T helper 17 (Th17) cells, a newly identified subset of CD4+ T cells, exhibit significant pro-inflammatory and pro-fibrotic capabilities. Advancements in TAO treatment have significantly improved management strategies. Targeted therapies like teprotumumab, an IGF-1R antagonist, have revolutionized treatment, showing remarkable efficacy in reducing proptosis and improving patient outcomes. Biologics such as tocilizumab, an IL-6 receptor antagonist, and rituximab, a CD20-targeting monoclonal antibody, offer additional options for refractory cases by specifically targeting inflammatory pathways. Traditional nonspecific therapies, including corticosteroids and immunosuppressive agents like mycophenolate mofetil, cyclosporine, and azathioprine, remain crucial in controlling inflammation. Antioxidants such as selenium and statins have shown potential benefits in reducing oxidative stress and inflammation. Innovations in surgical techniques, including endoscopic and minimally invasive approaches for orbital decompression, have enhanced functional and cosmetic outcomes, reducing morbidity and improving patient satisfaction. Supportive measures, such as ocular surface management, smoking cessation, and psychological support, are essential for comprehensive care and improving quality of life.

Keywords

Graves ophthalmopathy · Thyroid associated ophthalmopathy · Diagnosis · Management, recent advances