Graves Orbitopathy: Update on Diagnosis and Therapy

Eugen Melcescu, William B. Horton, Daniel Kim, Vani Vijayakumar, James J. Corbett, Kimberly W. Crowder, Karen T. Pitman, Gabriel I. Uwaifo, Christian A. Koch

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Graves orbitopathy (GO) is an autoimmune disorder representing the most frequent extrathyroidal manifestation of Graves disease. It is rare, with an age-adjusted incidence of approximately 16.0 cases per 100,000 population per year in women and 2.9 cases per 100,000 population per year in men. GO is an inflammatory process characterized by edema and inflammation of the extraocular muscles and an increase in orbital connective tissue and fat. Despite recent progress in the understanding of its pathogenesis, GO often remains a major diagnostic and therapeutic challenge. It has become increasingly important to classify patients into categories based on disease activity at initial presentation. A Hertel exophthalmometer measurement of >2 mm above normal for race usually categorizes a patient as having moderate-to-severe GO. Encouraging smoking cessation and achieving euthyroidism in the individual patient are important. Simple treatment measures such as lubricants for lid retraction, nocturnal ointments for incomplete eye closure, prisms in diplopia, or botulinum toxin injections for upper-lid retraction can be effective in mild cases of GO. Glucocorticoids, orbital radiotherapy, and decompression/rehabilitative surgery are generally indicated for moderate-to-severe GO and for sight-threatening optic neuropathy. Future therapies, including rituximab aimed at treating the molecular and immunological basis of GO, are under investigation and hold promise for the future.

Original languageEnglish (US)
Pages (from-to)34-43
Number of pages10
JournalSouthern medical journal
Issue number1
StatePublished - Jan 2014
Externally publishedYes


  • Graves disease
  • glucocorticoids
  • orbitopathy
  • rituximab
  • thyroid-stimulating immunoglobulin

ASJC Scopus subject areas

  • General Medicine


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