This protocol addresses Graves' orbitopathy classified as mild — a presentation characterised by exophthalmos within a defined threshold, minor lid retraction, and mild soft-tissue involvement. The central clinical question is whether the impact on the patient's quality of life justifies intervention.
These features have only a minor impact on daily life — insufficient on their own to mandate treatment — yet the effect on quality of life remains the pivotal consideration that shapes management.
When the disease's impact on quality of life outweighs the associated risks, a form of immunomodulatory or surgical intervention may be considered, depending on disease activity status. Any such decision follows extensive counseling and shared decision-making with the patient. The full treatment algorithm — including criteria for each pathway — is available in the complete protocol.
DOI: 10.1530/EJE-21-0479
Patients whose features of GO have only a minor impact on daily life that have insufficient impact to justify immunomodulation or surgical treatment.
minor lid retraction (<2 mm) · mild soft-tissue involvement · exophthalmos <3 mm above normal for race and gender · no or intermittent diplopia and corneal exposure responsive to lubricants
If the impact of the disease on the QoL outweighs risks, then low-dose immunomodulatory therapy (active GO) or rehabilitative surgery (inactive GO) is proposed subsequent to extensive counseling and shared decision.
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