Effects of treatment modalities for Graves’ hyperthyroidism on Graves’ orbitopathy: a 2015 Italian Society of Endocrinology Consensus Statement

Abstract

Graves’ disease is the most frequent form of hyperthyroidism in iodine sufficient countries [ 1 ], and Graves’ orbitopathy (GO) is its most important and common extrathyroidal manifestation [ 2 ], affecting about 25 % of patients [ 3 ]. Although GO is generally mild and rarely progressive [ 4 ], thyroid dysfunction, both hyperthyroidism and hypothyroidism, can influence its course. GO has been reported to improve after correction of hyperthyroidism with antithyroid drug (ATD) treatment [ 5 ], or to occur or worsen after a period of uncontrolled hypothyroidism [ 6 ]. Accordingly, the European Group on Graves’ Orbitopathy (EUGOGO) Consensus Statement few years ago recommended that restoration and maintenance of euthyroidism are priorities in Graves’ disease patients with GO [ 7 ]. How to treat hyperthyroidism when GO is present is, however, a challenging dilemma [ 8 ]. Are current modalities for hyperthyroidism [ATDs, radioiodine (RAI), thyroidectomy] per se capable to affect the course of GO? If orbital disease is present, is it preferable to control hyperthyroidism with ATDs or may thyroid ablation (RAI, thyroidectomy, alone or in association) be advantageous by removing factors (thyroid autoreactive lymphocytes, thyroid antigens) that may promote the occurrence and/or progression of GO? To address these questions, the Italian Society of Endocrinology established a task force of experts with the aim of reviewing the available literature and drawing conclusions based on evidence summary of recommendations is presented in Table 1 .