Medical Management of Thyroid-Associated Orbitopathy

The management of thyroid-associated orbitopathy is complex and it is mandatory that the treatment is provided as part of a multidisciplinary team, including ophthalmologist, orthoptist, endocrinologist and the family doctor. Thyroid dysfunction must be managed together with comorbidities, such as smoking and diabetes mellitus, that have to be addressed simultaneously. Treatment should be started at the time of diagnosis to decrease the final severity of the disease, as it is more effective when initiated early in the active phase of the disease. Both hyperthyroidism and hypothyroidism negatively influence TAO. Hypothyroidism can be corrected with oral supplementation; hyperthyroidism can be treated with antithyroid drugs, radio-active iodine, and thyroidectomy. Establishing whether a patient has active or inactive TAO is important; immunosuppression with corticosteroids or orbital radiotherapy are effective in the active stage of the disease, and surgical treatments should only be undertaken when the disease is inactive and has remained stable for at least 3–6 months.