Graves' orbitopathy (GO) is characterized by inflammation of orbital connective tissues that develops in around 25-70% of patients with Graves' disease (GD). As the most common extrathyroidal manifestation of GD, the annual incidence of GO is three cases per 100,000 males and 16 cases per 100,000 females. GO has puzzled generations of clinicians and scientists because of its diverse clinical manifestations, obscure pathogenesis, and the challenges posed by its management. Typically, the natural history of GO includes an active, inflammatory stage, followed by chronic stabilization and quiescence status. It is recognized that the pathological processes of GO include inflammatory infiltration of various immune cells into retro-orbital tissues, de novo adipogenesis, and overproduction of extracellular matrix leading to fibrosis. Advances in recent years have helped elucidate some of the pathogenetic mechanisms of GO, particularly the genetic background, the immune response, the role of thyrotropin receptor and insulin-like growth factor 1 receptor. Although intravenous use of glucocorticoids has been established as a superior therapeutic approach, the use of immunomodulation therapy is currently being investigated. Results from some current clinical trails are promising.
The aim of this Research Topic is to highlight recent advances, new technologies, and challenges in the field of GO, especially the underlying mechanisms and targeted therapies. We have identified the following areas of GO research where new discoveries were made recently which have led to new questions and challenges for the future:
• Adipogenesis and fibrosis
• B cell and autoantibody
• Effector and regulatory T cell
• Emerging therapeutic agent
• Fibrocyte and orbital fibroblast
• Genetics and epigenetics of thyroid
• GO and GD animal model
• Microbiota and thyroid autoimmunity
• TSHR and IGF-1R crosstalk
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Journal of Medical and surgical pathology