Treatment of Graves' Disease with Mild Active Thyroid Eye Disease
When Graves' disease presents alongside mild active thyroid eye disease (Graves' orbitopathy),
management focuses on protecting the ocular surface and preventing progression to more severe forms.
Clinical scenario
This protocol targets patients with Graves' disease who have mild, active thyroid eye
disease (Graves' orbitopathy). Preserving a healthy ocular surface and limiting
progression are the primary concerns in this setting.
Management approach
Care is built around local supportive measures for the ocular surface, targeted supplementation,
and lifestyle modification including smoking cessation — the complete structured regimen,
agent selection, and full sequencing are available in the protocol below.
Full evidence-based regimen available below ↓
References
DOI: 10.1016/j.ecl.2021.12.004.
- For mild, active TED, topical artificial tears in drop, gel, and ointment (1% methylcellulose drops and/or petrolatum jelly) are key to maintaining a healthy ocular surface.
- Selenium supplementation has been shown to improve the course of mild TED in areas of relative selenium deficiency.
- Local measures to improve symptoms may include eye shades, artificial tears, elevation of head during sleep, and avoidance of eye cosmetics.
- Topical cyclosporine has been shown to be beneficial in reducing ocular surface inflammation.
- Currently, the ETA/European Group on Graves' Orbitopathy (EUGOGO) recommends 6 months of selenium supplementation in patients with mild TED of short duration since it may improve eye manifestations and quality of life and prevent TED progression to severe forms.
- Clinicians should advise their patients with GD to stop smoking and refer them to a structured smoking cessation program.
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