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The authors state that: “Among the treatments available for Graves’ diseases, it has been found that antithyroid drugs and thyroid gland excision fail to modify the course of the ocular disease”, and subsequently indicate: “However, total thyroid gland ablation, compared with isolated thyroidectomy, does yield a significant and early improvement in the activity of GO”. We believe that these two statements may raise questions and should perhaps be further clarified. With respect to the use of glucocorticoids, the authors cite sources that recommend different treatment regimens and doses, including intravenous boluses of 250 mg, 500 mg, and 1000 mg. In our opinion, a comment on the mechanism of action of glucocorticoids based on the activated action mechanism, whether genomic or non-genomic, could explain the choice of dose: 250 mg or 500 mg, instead of 1000 mg.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In addition, the review includes a subsection titled “Cyclosporine/mTOR inhibitors”. We believe that it would be appropriate to define acronym mTORc; i.e., mammalian target of rapamycin complex. Interestingly, the authors do not mention any mTORc inhibitor drug, such as rapamycin (Sirolimus), that have been used in the treatment of both acute and delayed or fibrotic forms of GO.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In section “Other treatments”, a mention or comment on the latest drugs used in this field, such as ATX-GD-59, immunotherapy restoring tolerance to the thyroid stimulating hormone (TSH) receptor, K1-70 monoclonal autoantibodies (TSH receptor-blocking protein), or anti CD-40 antibody iscalimab,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> would have been appreciated.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alijotas-Reig J. Tratamiento de la oftalmopatía de Graves. Med Clin (Barc). 2022;158:93.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratamiento de la oftalmopatía de Graves" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Gonzalez-García" 1 => "M. Sales-Sanz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medclin2020.07.031" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)." "fecha" => "2021" "volumen" => "156" "paginaInicial" => "180" "paginaFinal" => "186" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33069387" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sirolimus (rapamycin) for the targeted treatment of the fibrotic sequelae of Graves’ orbitopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.C.P. Roos" 1 => "R. Murthy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41433-019-0340-3" "Revista" => array:6 [ "tituloSerie" => "Eye (Lond)." "fecha" => "2019" "volumen" => "33" "paginaInicial" => "679" "paginaFinal" => "682" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30755726" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Novel approaches for immunosuppression in Graves’ hyperthyroidism and associated orbitopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.C.H. Hong Leea" 1 => "G.J. Kahalyb" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000508789" "Revista" => array:7 [ "tituloSerie" => "Eur Thyroid J." "fecha" => "2020" "volumen" => "9" "numero" => "suppl 1" "paginaInicial" => "17" "paginaFinal" => "30" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33511082" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015800000002/v1_202201220701/S2387020621006884/v1_202201220701/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015800000002/v1_202201220701/S2387020621006884/v1_202201220701/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006884?idApp=UINPBA00004N" ]
Journal Information
Vol. 158. Issue 2.
Pages 93 (January 2022)
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Vol. 158. Issue 2.
Pages 93 (January 2022)
Letter to the Editor
Treatment of Graves' ophthalmopathy
Tratamiento de la oftalmopatía de Graves
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8
Jaume Alijotas-Reig
Unidad de Enfermedades Autoinmunes Sistémicas, Servicio de Medicina Interna, Hospital Universitari Vall d’Hebron, Profesor Agregado, Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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