Update on Graves Disease

Advances in Treatment of Mild, Moderate and Severe Thyroid Eye Disease

Diego Strianese


Curr Opin Ophthalmol. 2017;28(5):505-513. 

In This Article


The antioxidative effect of selenium, which may interfere with TED progression, represents an advance in TED therapy, particularly for mild disease. However, the actual benefit and efficacy in some populations should be further assessed, as high blood levels of selenium have been shown to carry a risk for development of other diseases. The use of biological agents is an attractive advancement in TED therapy, attempting to target a specific mechanism with the hope to minimize disease progression and duration. Although many studies have demonstrated the efficacy of the biological immunosuppressive agents, particularly RTX, others have refuted the effectiveness. Methotrexate appears to be a valid alternative therapy in steroid-dependent patients. Teprotumumab appears very effective in reducing the proptosis, but further studies are necessary to confirm these data. The use should be limited to steroid-resistant or steroid-dependent patients. Although considerable progress has been achieved in understanding the pathogenesis of the TED, much remains to be achieved, particularly, which step in the cascade of events should be addressed by novel therapies to interrupt the process.