Marinò M, Barbesino G, Pinchera A, Manetti L, Ricciardi R, Rossi B, Muratorio A, Braverman L E, Mariotti S, Chiovato L
Department of Endocrinology, University of Pisa, Italy.
Thyroid. 2000 Sep;10(9):799-802. doi: 10.1089/thy.2000.10.799.
We previously showed that myasthenia gravis (MG) has a mild clinical expression when associated with autoimmune thyroid diseases (AITD). In the present study we have investigated the frequency of thyroid-associated ophthalmopathy (TAO) in patients with Graves' disease (GD) associated with MG as compared with GD patients without MG. A total of 418 patients with GD were studied, 31 with MG and 387 without MG. TAO was evaluated by physical examination, exophthalmometry, computerized tomography, and computerized visual fields assessment. The overall prevalence of TAO was similar in GD patients with MG (61.2%) and in those without MG (56.4%). When the analysis was restricted to GD patients with ocular MG, a greater frequency of TAO was found (84.6%), compared with GD patients without MG or with GD patients with generalized MG, although the differences did not reach the statistical significance. GD patients with MG had a significantly greater prevalence (12.9%) of euthyroid ophthalmopathy (clinically overt ophthalmopathy without previous and/or current hyperthyroidism) than those without MG (3.1%; p = 0.003). The results suggest a preferential association between the ocular manifestations of GD and MG, which may be due to immunological cross-reactivity against common autoimmune targets in the eye muscle as well as to a common genetic background.
我们之前的研究表明，重症肌无力（MG）与自身免疫性甲状腺疾病（AITD）相关时临床症状较轻。在本研究中，我们调查了合并MG的格雷夫斯病（GD）患者与不合并MG的GD患者相比，甲状腺相关性眼病（TAO）的发生率。共研究了418例GD患者，其中31例合并MG，387例不合并MG。通过体格检查、眼球突出度测量、计算机断层扫描和计算机视野评估对TAO进行评估。合并MG的GD患者中TAO的总体患病率（61.2%）与不合并MG的患者（56.4%）相似。当分析仅限于眼部MG的GD患者时，与不合并MG的GD患者或合并全身型MG的GD患者相比，TAO的发生率更高（84.6%），尽管差异未达到统计学意义。合并MG的GD患者中甲状腺功能正常的眼病（临床上明显的眼病，既往和/或目前无甲状腺功能亢进）的患病率（12.9%）显著高于不合并MG的患者（3.1%；p = 0.003）。结果表明GD和MG的眼部表现之间存在优先关联，这可能是由于针对眼肌中常见自身免疫靶点的免疫交叉反应以及共同的遗传背景所致。
