Schwartz Kara M, Fatourechi Vahab, Ahmed Debra D F, Pond Gregory R
Department of Dermatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Clin Endocrinol Metab. 2002 Feb;87(2):438-46. doi: 10.1210/jcem.87.2.8220.
Little is known about the long-term outcome of patients with thyroid dermopathy, an extrathyroidal manifestation of Graves' disease. Also, it is not known to what degree treatment promotes remission of the lesions. The present report supplies information on the natural course of mild, untreated and severe, treated thyroid dermopathy. In this study, we report on the outcomes of 178 patients seen at our institution between January 1969 and November 1995 with thyroid dermopathy who were followed up for an average of 7.9 yr. Nonpitting edema was the most prevalent form of dermopathy (43.3%), and the pretibial area was the region most commonly involved (99.4%). The majority of patients with dermopathy had ophthalmopathy (97.0%). Topical corticosteroids were the most commonly used treatment (53.9%). Patients with milder forms of dermopathy (40.4%) did not receive any therapy for dermopathy. Twenty-six percent of the patients experienced complete remission, 24.2% had moderate improvement (partial remission), and 50.0% had no or minimal improvement of their dermopathy at last follow-up. Patients who did not receive therapy experienced a significantly (P = 0.03) higher rate of complete remission (34.7%) than those who received local therapy (18.7%), although the combined complete and partial remission rates were not significantly different for the treated and untreated groups (P = 0.3). However, the treated and untreated groups were not comparable because our practice is to use therapy for more extensive and severe cases. All five cases of elephantiasis were in the treatment group and were less likely to have remission because of the severity of their skin condition. Patients receiving treatment were more likely to have dermatologic consultation and histologic diagnosis (P < 0.001). The beneficial effect of topical corticosteroid therapy on long-term remission rates remains to be determined.
关于甲状腺皮肤病（格雷夫斯病的一种甲状腺外表现）患者的长期预后知之甚少。此外，治疗在何种程度上能促进病变缓解也不清楚。本报告提供了轻度、未经治疗的甲状腺皮肤病以及重度、经治疗的甲状腺皮肤病自然病程的相关信息。在本研究中，我们报告了1969年1月至1995年11月期间在我们机构就诊的178例甲状腺皮肤病患者的预后情况，这些患者平均随访了7.9年。非凹陷性水肿是最常见的皮肤病形式（43.3%），胫前区是最常受累的部位（99.4%）。大多数皮肤病患者患有眼病（97.0%）。外用皮质类固醇是最常用的治疗方法（53.9%）。病情较轻的皮肤病患者（40.4%）未接受任何皮肤病治疗。在最后一次随访时，26%的患者完全缓解，24.2%有中度改善（部分缓解），50.0%的患者皮肤病无改善或改善极小。未接受治疗的患者完全缓解率（34.7%）显著高于接受局部治疗的患者（18.7%）（P = 0.03），尽管治疗组和未治疗组的完全缓解和部分缓解合并率无显著差异（P = 0.3）。然而，治疗组和未治疗组不可比，因为我们的做法是对病情更广泛、更严重的病例进行治疗。所有5例象皮病患者均在治疗组，由于皮肤状况严重，缓解的可能性较小。接受治疗的患者更有可能接受皮肤科会诊和组织学诊断（P < 0.001）。外用皮质类固醇治疗对长期缓解率的有益作用仍有待确定。
