Graves’ orbitopathy (GO) is a disfiguring, inflammatory disease, with an incidence of 10/10,000
Persons, typically associated with autoimmune thyroid diseases, i.e., Graves’ disease and hypothyroid autoimmune thyroiditis. Only in a minority of patients (1-2%) GO is observed in the absence of overt thyroid dysfunction, but still with subclinical signs of thyroid autoimmunity, namely the presence of thyroid-directed autoantibodies. It is well accepted that GO is an autoimmune disease, being the thyroid-stimulating hormone receptor (TSH-R) the major autoantigen. Recently, a major role of the insulin-like growth factor-1 receptor (IGF-1R) has emerged. Depending on the severity and the activity of the disease, GO patients should receive different treatments and their management could be complex. The first line treatment available for patients with moderate-to-severe, active GO is intravenous glucocorticoids plus mycophenolate. However, the recently published guidelines of the European Group on Graves’ orbitopathy (EUGOGO) point out that the optimal treatment is yet to be identified, as none of the available procedures result in a complete long-term response in all patients. In this regard, the research on GO pathogenesis is still ongoing, aimed at comprehending its mechanisms and risk factors and identifying novel therapeutic targets.
Over the years, several environmental risk factors for GO have been reported, among which smoking, uncontrolled thyroid function, and oxidative stress. Recently, a role of hypercholesterolemia has been reported as well. The recent acquisitions on the pathogenesis of GO, including the role of IGF-1R and the recently shown role of epigenetic mechanisms have driven the ongoing changes in patient management. Therefore, new treatment procedures have been proposed. These include using selenium in mild GO, the association of intravenous glucocorticoids (ivGC) and mycophenolate, monoclonal antibodies against IGF-1R (teprotumumab), interleukin-6 receptor (tocilizumab), and CD20 (rituximab). Very recently, it has been reported that atorvastatin improves the outcome to treatment with methylprednisolone in hypercholesterolemic patients with moderate-to-severe, active GO.
This Research Topic will include original research articles, reviews, perspectives, and opinion articles providing novel achievements regarding the management of patients and treatments for GO, with emphasis on recent basic and clinical research. The topic is intended to further energize the ongoing discussion on the need to find an effective long-term therapy for patients with moderate to severe and active GO.
Graves’ orbitopathy (GO) is a disfiguring, inflammatory disease, with an incidence of 10/10,000
Persons, typically associated with autoimmune thyroid diseases, i.e., Graves’ disease and hypothyroid autoimmune thyroiditis. Only in a minority of patients (1-2%) GO is observed in the absence of overt thyroid dysfunction, but still with subclinical signs of thyroid autoimmunity, namely the presence of thyroid-directed autoantibodies. It is well accepted that GO is an autoimmune disease, being the thyroid-stimulating hormone receptor (TSH-R) the major autoantigen. Recently, a major role of the insulin-like growth factor-1 receptor (IGF-1R) has emerged. Depending on the severity and the activity of the disease, GO patients should receive different treatments and their management could be complex. The first line treatment available for patients with moderate-to-severe, active GO is intravenous glucocorticoids plus mycophenolate. However, the recently published guidelines of the European Group on Graves’ orbitopathy (EUGOGO) point out that the optimal treatment is yet to be identified, as none of the available procedures result in a complete long-term response in all patients. In this regard, the research on GO pathogenesis is still ongoing, aimed at comprehending its mechanisms and risk factors and identifying novel therapeutic targets.
Over the years, several environmental risk factors for GO have been reported, among which smoking, uncontrolled thyroid function, and oxidative stress. Recently, a role of hypercholesterolemia has been reported as well. The recent acquisitions on the pathogenesis of GO, including the role of IGF-1R and the recently shown role of epigenetic mechanisms have driven the ongoing changes in patient management. Therefore, new treatment procedures have been proposed. These include using selenium in mild GO, the association of intravenous glucocorticoids (ivGC) and mycophenolate, monoclonal antibodies against IGF-1R (teprotumumab), interleukin-6 receptor (tocilizumab), and CD20 (rituximab). Very recently, it has been reported that atorvastatin improves the outcome to treatment with methylprednisolone in hypercholesterolemic patients with moderate-to-severe, active GO.
This Research Topic will include original research articles, reviews, perspectives, and opinion articles providing novel achievements regarding the management of patients and treatments for GO, with emphasis on recent basic and clinical research. The topic is intended to further energize the ongoing discussion on the need to find an effective long-term therapy for patients with moderate to severe and active GO.