Therapeutic Objective
- In the presence of Graves’ disease: achievement of a euthyroid metabolic state (= thyroid values in the normal range).
Therapy recommendations
- In the presence of Graves’ disease: see below Graves’ disease/drug therapy.
- In case of progression of orbitopathy (immunologically caused inflammation of the orbital contents/protruding eyes) despite euthyroid metabolic state → high-dose therapy with glucocorticoids (prednisolone/methylprdnisolone); in rare cases, retrobulbar radiotherapy if necessary.
- The monoclonal antibody teprotumumab may be the first effective drug for the treatment of exophthalmos (protrusion of the eyeball) in Graves’ disease. The antibody binds to the receptor for insulin-like growth factor 1 (IGF-1), which promotes the proliferation of fibroblasts in the eye socket.
- In a phase III study, the compound led to a significant decrease in exophthalmos and double vision (diplopia) in patients with endocrine orbitopathy.
Note: In endocrine orbitopathy, both hyperthyroid episodes (hyperthyroidism) and periods of hypothyroidism (hypothyroidism) can adversely affect orbital (eye socket) findings.
