Graves orbitopathy (thyroid eye disease)

An autoimmune inflammatory disease of orbital fat and extraocular muscles in patients with Graves disease. Presents with exophthalmos, lid retraction, diplopia, and in severe cases optic neuropathy. Standard therapy: thyroid function normalisation; in active disease, glucocorticoids and teprotumumab.

ICD-10 H06.21 drug

Also known as: Thyroid eye disease, TED

Drugs used for this condition

BSelenium (oral salts and chelates: selenomethionine, sodium selenite, selenium yeast)Add-on therapy · Mineral supplements. Trace elementsSelenomethionine 100 µg twice daily for 6 months in patients with mild-to-moderate active thyroid eye disease showed improved quality of life and slowed disease progression in the NEJM 2011 RCT (159 patients). ETA 2021 included selenium in mild Graves orbitopathy recommendations as a level A evidence agent. The effect is more pronounced in Europe (a low-selenium soil region); in the US and Japan the effect was smaller.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit