Is prevention of Graves ophthalmopathy (orbitopathy) possible?
Luigi Bartalena: Graves ophthalmopathy, or better orbitopathy, is the main extrathyroidal manifestation of Graves disease. It affects around 25% to 30% of Graves patients. It is an invalidating disease and therefore we should try to prevent its occurrence. Of course, we cannot do that in old patients, but it is very well known that Graves orbitopathy, or ophthalmopathy, derives from a complex interplay between genetic, uncontrollable factors and environmental factors, which can to some extent be controlled, leading to some prevention of the disease.
The most important environmental exogenous factors are smoking, thyroid dysfunction, thyroid-stimulating hormone (TSH) receptor antibodies, and oxidative stress. Therefore, for prevention of orbitopathy, it would be really important to urge patients to refrain from smoking, to control promptly and to maintain a stable control of thyroid dysfunction, both hyper- and hypothyroidism, to reduce TSH receptor antibodies – this usually occurs with the pharmacological treatment of hyperthyroidism – and to reduce oxidative stress; as shown by randomized clinical trials, this may be achieved by a 6-month course of selenium.