Medical management of extrathyroidal manifestation of graves disease

To review preventive measures and the current medical management of extrathyroidal manifestation of Graves disease and to provide an overview of potential immune therapies.Methods: A literature review of investigative trials of treatments for Graves disease and its extrathyroidal manifestations.Results: Given new knowledge of the stages of the autoimmune cascade responsible for the development of these extrathyroidal manifestations, the possibility has been raised of performing randomized trials of agents shown to provide benefits in other immune conditions. Two randomized trials on the efficacy of rituximab in moderate-to-severe Graves ophthalmopathy have reported conflicting results.Conclusion: Additional studies of rituximab and other agents are needed before they become routinely used in treating Graves disease. Meanwhile, the standard medical therapy for moderate-to-severe ophthalmopathy is intravenous (IV) or oral corticosteroids and, for dermopathy, local corticosteroid application with occlusive dressing. Because major adverse effects such as life-threatening hepatic failure can occur with very high doses of IV prednisolone, the cumulative total dose should not exceed 8 g.