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Vol. 156. Issue 4.
Pages 180-186 (February 2021)
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Vol. 156. Issue 4.
Pages 180-186 (February 2021)
Review
Treatment of Graves’ ophthalmopathy
Tratamiento de la oftalmopatía de Graves
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Andrés González-Garcíaa,
Corresponding author
, Marco Sales-Sanzb
a Unidad de Enfermedades Sistémicas Autoinmunes y Minoritarias, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
b CSUR de tumores orbitarios y cirugía de descompresión orbitaria en Oftalmopatía Tiroidea. Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
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Table 1. Classification and treatment recommendations in Graves' ophthalmopathy.
Table 2. Recommendations for monitoring drugs used in Graves' ophthalmopathy.
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Abstract

Graves' ophthalmopathy is an inflammatory disease with primary involvement of the extraocular muscles and the orbit. It encompasses the most common extra-thyroid manifestation in patients with Graves-Basedow disease. The underlying cause is molecular mimicry with the TSH receptor in ocular fibroblasts, leading to an immuno-mediated pathogenesis. Glucocorticoids at high doses are the cornerstone in moderate-severe cases. However, some patients are corticorresistant or intolerant. In recent years, therapeutic novelties have been described in terms of the dosage of the immunosuppressive treatments used, as well as the emergence of biological therapy in this field. The objective of this review is to update the treatment of Graves’ ophthalmopathy, as well as to present alternative options in patients resistant or intolerant to glucocorticoids.

Keywords:
Graves-Basedow disease
Graves' ophthalmopathy
Orbitopathy
Glucocorticoids
Teprotumumab
Rituximab
Tocilizumab
Resumen

La oftalmopatía de Graves constituye una enfermedad inflamatoria con afectación fundamental de los músculos extraoculares y de la órbita, y representa la principal manifestación extratiroidea en los pacientes con enfermedad de Graves-Basedow. La etiopatogenia subyacente es inmunomediada mediante un mimetismo molecular con el receptor de la TSH en los fibroblastos oculares. El principal tratamiento en los casos moderados-graves se basa en la inmunosupresión sistémica, y son de elección los glucocorticoides a dosis altas. Sin embargo, algunos pacientes presentan intolerancia al tratamiento o mala respuesta a los glucocorticoides. En los últimos años se han descrito novedades terapéuticas en cuanto a la posología de los tratamientos inmunosupresores empleados, así como la irrupción de la terapia biológica en este campo. El objetivo de esta revisión es actualizar el tratamiento de la oftalmopatía inflamatoria, así como presentar opciones terapéuticas alternativas en aquellos casos corticoresistentes o con intolerancia a glucocorticoides.

Palabras clave:
Enfermedad de Graves-Basedow
Inflamación orbitaria
Orbitopatía
Glucocorticoides
Teprotumumab
Rituximab
Tocilizumab

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