Graves' ophthalmopathy

Graves' ophthalmopathy (GO) is the most common orbital disease in adults and develops in 25% to 50% of patients with Graves' disease (GD). Although thyroid manifestations of GD can be effectively managed, the optimal treatment of GO has remained challenging. The natural history of GO is variable. Patients should be treated according to the severity and activity of their eye disease. Treatment should include control of thyroid function, relief of symptom and reduction of inflammation in the periorbital tissues. Smoker should be educated to quit smoking aggressively. Most patients have mild disease and do not have progression during follow-up. Anti-thyroid drugs and thyroidectomy do not have a negative influence on the course of GO. However, there is increasing evidence that radioiodine therapy can cause the development or worsening of GO. Glucocorticoids(GCs) are the preferred first-line treatment for moderate and severe GO. IV GCs is more effective than oral GCs. Radiation and surgical decompression can also be used in selected patients.