Table 1.

Summary of recommendations

Recommendation number	Statement	Strength and level of evidence
1	In patients with newly diagnosed Graves’ hyperthyroidism, euthyroidism should be promptly restored by antithyroid drugs, and then stably maintained	1, ØØØØ
2	Thyroid status should be assessed frequently during the initial phase of antithyroid drug treatment and regularly thereafter, to avoid fluctuations in thyroid status potentially detrimental for GO	1, ØØØO
3	Steroid prophylaxis is recommended in patients receiving radioiodine treatment, if mild and active GO preexists or there are risk factors for radioiodine-associated GO development or progression	1, ØØØØ
4	Pros and cons of steroid prophylaxis after radioiodine treatment should be thoroughly discussed also with patients with absent or inactive GO prior to radioiodine treatment	1, ØOOO
5	If surgery is selected, near-total/thyroid thyroidectomy should be preferred to subtotal thyroidectomy, because the former is associated with a higher rate of successful treatment of hyperthyroidism, with no differences in the outcome of GO; steroid prophylaxis is not required	1, ØØØØ
6	If surgery for Graves’ hyperthyroidism is selected in patients with GO, post-operative remnant ablation may be considered, because this inactivates the disease earlier and allows prompter rehabilitative surgery, if needed	2, ØØØO
7	Patients who have mild and active GO and are treated with antithyroid drugs should receive a 6-month selenium supplementation	1, ØØØO
8	The modality of treatment for hyperthyroidism in patients with mild and active GO should be selected independently of GO	1, ØOOO
9	The modality of treatment for hyperthyroidism in patients with mild and inactive GO should be selected independently of GO	1, ØOOO
10	In patients with moderate-to-severe and active GO, treatment of GO should be priority, and euthyroidism should be promptly restored and stably maintained	1, ØØØO
11	In patients with moderate-to-severe and active GO, large, multicenter randomized clinical trials should be designed to establish whether the conservative or the ablative approach is preferable for the long-term outcome of GO	1, ØOOO
12	In patients with moderate-to-severe and inactive GO, treatment of hyperthyroidism should be independent of residual GO manifestations	1, ØØOO
13	Hyperthyroid patients with sight-threatening GO should be treated with antithyroid drugs until dysthyroid optic neuropathy or corneal breakdown is cured and GO is inactive	1, ØØOO