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Luigi Bartalena Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Varese, Italy

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Lelio Baldeschi Department of Ophthalmology, Hospital Saint Luc, Catholic University of Louvain, Brussels, Belgium

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Kostas Boboridis Ophthalmology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece

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Anja Eckstein Zentrum für Augenheilkunde, Universitätsklinikum Essen, Essen

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George J. Kahaly Department of Medicine I, Johannes Gutenberg University (JGU) Medical Center, Mainz, Germany

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Claudio Marcocci Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

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Petros Perros Department of Endocrinology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

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Mario Salvi Graves' Orbitopathy Center, Endocrinology, Fondazione Ca' Granda IRCCS, University of Milan, Milan, Italy

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Wilmar M. Wiersinga Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

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Introduction In 2008, EUGOGO published a consensus statement on the management of Graves' orbitopathy (GO) simultaneously in the European Journal of Endocrinology and in Thyroid [ 1 , 2 ]. The statement was received very well [ 3 ] and has

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Giulia Masetti Thyroid Research Group, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom
Computational Metagenomics, CIBIO Department, University of Trento, Trento, Italy

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Marian Ludgate Thyroid Research Group, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom

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), causing hyperthyroidism. About half of GD patients also have Gravesorbitopathy (GO), in which cross-reacting autoimmune responses to thyroid/orbit shared antigens (notably the TSHR) lead to expansion of the orbital contents. The overproduction of

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Elena Sabini Endocrinology Units, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Marenza Leo Endocrinology Units, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Barbara Mazzi Endocrinology Units, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Roberto Rocchi Endocrinology Units, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Francesco Latrofa Endocrinology Units, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Marco Nardi Ophthalmopathy Unit I, Department of Surgical, Medical and Molecular Pathology, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Paolo Vitti Endocrinology Units, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Claudio Marcocci Endocrinology Units, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Michele Marinò Endocrinology Units, Department of Clinical and Experimental Medicine, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Introduction Gravesorbitopathy (GO) is a disfiguring and disabling disease that profoundly impairs the quality of life of affected patients [ 1 - 4 ]. The natural history of GO is characterized by an initial phase in which signs and symptoms

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C. Daumerie Departments of Endocrinology, Université catholique de Louvain, University Hospital St-Luc, Brussels, Belgium

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A. Boschi Departments of Ophthalmology, Université catholique de Louvain, University Hospital St-Luc, Brussels, Belgium

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P. Perros Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK

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What Is Known So Far on This Topic? • Hypothyroidism is thought to have a detrimental effect on Gravesorbitopathy (GO), though it is unclear whether this is mediated by TSH or the hypothyroid state. • A possible association between

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Elena Sabini Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Ilaria Ionni Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Roberto Rocchi Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Paolo Vitti Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Claudio Marcocci Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy

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Michele Marinò Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy

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What Is Known about This Topic? Gravesorbitopathy is believed to be the consequence of autoimmunity against antigens present both in the thyroid and in orbital tissues. Massive release of thyroid antigens causes the appearance or

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Luigi Bartalena Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy

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Introduction Management of Graves' orbitopathy (GO), the most important extrathyroidal expression of Graves' disease, remains a major challenge and dilemma [ 1 ]. Available therapies are largely imperfect, and a large proportion of patients

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Murat Faik Erdoğan Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Özgür Demir Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Reyhan Ünlü Ersoy Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey

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Kamile Gül Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey

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Berna İmge Aydoğan Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Ziynet Alphan Üç Department of Endocrinology and Metabolic Diseases, Ankara Training and Research Hospital, Ankara, Turkey

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Türkan Mete Endocrinology and Metabolic Diseases, Ankara Numune Training and Research Hospital, Ankara, Turkey

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Sibel Ertek Department of Endocrinology and Metabolic Diseases, Ufuk University Medical Faculty, Ankara, Turkey

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Uğur Ünlütürk Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Bekir Çakır Department of Endocrinology and Metabolic Diseases, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey

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Yalçın Aral Department of Endocrinology and Metabolic Diseases, Ankara Training and Research Hospital, Ankara, Turkey

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Serdar Güler Endocrinology and Metabolic Diseases, Ankara Numune Training and Research Hospital, Ankara, Turkey

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Sevim Güllü Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Demet Çorapçıoğlu Department of Endocrinology and Metabolic Diseases, Ankara University Medical Faculty, Ankara, Turkey

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Selçuk Dağdelen Department of Endocrinology and Metabolic Diseases, Hacettepe University Medical Faculty, Ankara, Turkey

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Gürbüz Erdoğan Department of Endocrinology and Metabolic Diseases, Ufuk University Medical Faculty, Ankara, Turkey

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Introduction Graves' orbitopathy (GO) is a devastating and disfiguring disease affecting appearance and functioning of the eyes and thus profoundly impairing the quality of life of affected individuals [ 1 ]. GO is an autoimmune disorder, but

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Elena Hoppe Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
Department of Paediatrics, Johannes Gutenberg University Medical Center, Mainz, Germany

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Alan Chun Hong Lee Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany

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David Hoppe Department of Psychology, Technical University of Darmstadt, Darmstadt, Germany

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George J. Kahaly Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany

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prolonged therapy required for GO incur tremendous indirect and direct costs [ 12 ]. The European Group on GravesOrbitopathy (EUGOGO) recommends the evaluation of QoL and psychological well-being by means of the GO-QoL questionnaire as an integral part

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Luigi Bartalena Department of Medicine and Surgery, University of Insubria, Varese, Italy

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Wilmar M. Wiersinga Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

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Introduction Ever since the report of Lord Brain in 1955, glucocorticoids have been the mainstay in the medical treatment of Gravesorbitopathy (GO) [ 1 ]. Intravenous glucocorticoid (IVGC) therapy is much more efficacious than placebo [ 2

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Liyun Shen Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Lei Ye Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Wei Zhu Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Qin Jiao Department of Ophthalmology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

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Yulin Zhou Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Shu Wang Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Weiqing Wang Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Guang Ning Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, State Key Laboratory of Medical Genomics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

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Introduction Gravesorbitopathy (GO) is the most common orbital disease in adults, which greatly affects patients’ quality of life ( 1 , 2 , 3 ). Although bioagents such as teprotumumab showed a promising new paradigm in GO treatment ( 4

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