A 65-year-old man with Grave's disease in remission for 3 years presents with recurrence. He now has moderate proptosis, chemosis, and diplopia. Thyroid eye disease activity score (CAS) is 5/7. TSI titre is markedly elevated. Regarding mycophenolate vs. IV glucocorticoids for active moderate-to-severe Graves' orbitopathy, which statement reflects current EUGOGO 2021 guidelines?

• A IV methylprednisolone alone is the gold standard first-line treatment
• B Mycophenolate in combination with IV glucocorticoids is superior to IV glucocorticoids alone ✓
• C Teprotumumab is recommended as first-line worldwide by EUGOGO 2021
• D Orbital radiotherapy should precede any systemic immunosuppression

Explanation

The MINGO trial (2021) demonstrated that adding mycophenolate mofetil to IV methylprednisolone produced significantly better overall response rate compared to IV methylprednisolone alone in active moderate-to-severe Graves' orbitopathy. EUGOGO 2021 guidelines adopted this combination as the standard of care for active disease with CAS ≥ 3. Teprotumumab (IGF-1R antagonist) is approved by FDA but is not yet included in EUGOGO first-line recommendations globally. Orbital radiotherapy is an adjunct, not a first step.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.