Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Thyroid. 2010 Jul;20(7):777-83. doi: 10.1089/thy.2010.1634.
Graves' ophthalmopathy (GO) significantly impairs the quality of life of affected individuals and the most severe cases can be sight threatening. Given the limited therapeutic options, a strong emphasis should be placed on disease prevention to diminish the significant morbidity associated with this disease.
GO is most prevalent in women and most severe in men. Although some genetic differences between GO patients and Graves' disease patients without ophthalmopathy have been identified, none of the polymorphisms identified to date impart a high enough risk of GO to justify genetic testing to guide therapy or preventive strategies. Poorly defined mechanical factors that appear also to play a role in GO susceptibility will likely be better elucidated with advances in imaging techniques. Tobacco smoking has been consistently linked to development or deterioration of GO. Smokers who receive radioactive iodine have the highest incidence of unfavorable GO outcome, which is proportional to the number of cigarettes smoked per day. Several studies have reported an association between radioactive iodine treatment for Graves' disease and worsening or development of GO. Observational studies suggest that the same appears to be true for thyroid dysfunction, including both hyper- and hypothyroidism. While thyrotropin receptor antibody levels appear to be useful in predicting the course of disease and response to therapy, it is not known whether they are predictive of GO development. The puzzling scenarios of euthyroid or clinically unilateral GO, the large number of nonsmoking GO patients, and the occasional development of GO years after thyroid dysfunction has been treated all underline the multifactorial etiology of this disorder in which no single factor determines the clinical outcome.
GO appears to have a complex genetic basis with multiple susceptibility alleles that act in combination with nongenetic factors to contribute to disease expression.
格雷夫斯眼病（GO）显著降低了患者的生活质量，严重者可导致视力受损。鉴于治疗方法有限，应高度重视疾病预防，以降低与该病相关的高发病率。
GO 最常发生于女性，在男性中最严重。尽管已经确定了 GO 患者与无眼病格雷夫斯病患者之间的一些遗传差异，但迄今为止发现的任何多态性都没有给 GO 带来足够高的风险，因此无法进行遗传检测来指导治疗或预防策略。一些尚未明确的机械因素似乎也在 GO 的易感性中发挥作用，随着成像技术的进步，这些因素将得到更好的阐明。吸烟一直与 GO 的发生或恶化有关。接受放射性碘治疗的吸烟者发生不良 GO 结局的几率最高，与每天吸烟的支数成正比。几项研究报告了 Graves 病放射性碘治疗与 GO 恶化或发生之间的关联。观察性研究表明，甲状腺功能障碍也是如此，包括甲状腺功能亢进和甲状腺功能减退。虽然促甲状腺激素受体抗体水平似乎可用于预测疾病过程和治疗反应，但尚不清楚它们是否可预测 GO 的发生。甲状腺功能正常或临床单侧 GO、大量不吸烟的 GO 患者以及甲状腺功能障碍治疗后数年偶尔发生 GO 等令人费解的情况，都突显了这种疾病的多因素病因，其中没有单一因素决定临床结局。
GO 似乎具有复杂的遗传基础，多个易感等位基因与非遗传因素共同作用，导致疾病表现。
