Graves disease is the most common cause of hyperthyroidism in iodine-sufficient areas. The main responsible mechanism is related to autoantibodies that bind and activate the thyrotropin receptor (TSHR). Although Graves hyperthyroidism is relatively common, no causal treatment options are available. Established treatment modalities are antithyroid drugs, which reduce thyroid hormone synthesis, radioactive iodine and surgery. However, emerging drugs that target the main autoantigen (monoclonal antibodies, small molecules, peptides) or block the immune pathway have been recently tested in clinical trials. Graves disease can involve the thyroid exclusively or it can be associated with extrathyroidal manifestations, among which Graves orbitopathy is the most common. The presence of Graves orbitopathy can change the management of the disease. An established treatment for moderate-to-severe Graves orbitopathy is intravenous glucocorticoids. However, recent advances in understanding the pathogenesis of Graves orbitopathy have allowed the development of new target-based therapies by blocking pro-inflammatory cytokine receptors, lymphocytic infiltration or the insulin-like growth factor 1 receptor (IGF1R), with several clinical trials providing promising results. This article reviews the new discoveries in the pathogenesis of Graves hyperthyroidism and Graves orbitopathy that offer several important tools in disease management.

Graves 病是碘充足地区甲状腺功能亢进症的最常见原因。主要负责机制与结合和激活促甲状腺激素受体 （TSHR） 的自身抗体有关。虽然 Graves 甲状腺功能亢进症相对常见，但没有因果治疗方案可供选择。既定的治疗方式是抗甲状腺药物，它可以减少甲状腺激素的合成、放射性碘和手术。然而，靶向主要自身抗原（单克隆抗体、小分子、肽）或阻断免疫途径的新兴药物最近已在临床试验中进行了测试。Graves 病可仅累及甲状腺，也可与甲状腺外表现相关，其中 Graves 眼眶病最常见。Graves 眼眶病的存在可以改变疾病的管理。中度至重度 Graves 眼眶病的既定治疗方法是静脉注射糖皮质激素。然而，最近对 Graves 眼眶病发病机制的理解进展允许通过阻断促炎细胞因子受体、淋巴细胞浸润或胰岛素样生长因子 1 受体 （IGF1R） 开发新的基于靶点的疗法，多项临床试验提供了有希望的结果。本文综述了 Graves 甲状腺功能亢进症和 Graves 眼眶病发病机制的新发现，这些发现为疾病管理提供了几个重要的工具。