This protocol addresses the management of Graves' orbitopathy in its mild, active phase — when disease features have only a minor impact on daily life and do not yet justify immunosuppressive or surgical intervention.
Disease is active (clinical activity score ≥3/7) but severity is limited. Typical features include:
The primary aims are improvement in clinical activity score and quality-of-life scores (GO-QOL) at 6 months, and reduced likelihood of disease progression.
Patients whose features of TED have only a minor impact on daily life insufficient to justify immunosuppressive or surgical treatment.
They usually have only one or more of the following: minor lid retraction (<2 mm), mild soft tissue involvement, proptosis <3 mm above normal for race and sex, transient or no diplopia, and corneal exposure responsive to lubricants.
Local and lifestyle measures and watchful monitoring will be sufficient in the majority of patients with mild disease, which in due course will remit completely or partially.
A single course of selenium selenite 100 µg twice daily for 6 months may be considered for patients with mild, active TED, particularly in regions of selenium insufficiency.
In patients with symptomatic inflammatory soft tissue involvement or if radioactive iodine is used (oral glucocorticoids prophylaxis).
After 6 months of therapy, improvements in CAS as well as in GO-QOL scores were noted with selenium therapy, but not with placebo, and persisted for an additional six months after therapy was stopped.
Overall, patients treated with selenium were more likely to have improvements in their TED, and less likely to have disease progression.
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