Department of Clinical Medicine, University of Insubria, Endocrinology Unit, Ospedale di Circolo, Viale Borri, 57, 21100 Varese, Italy.
J Clin Endocrinol Metab. 2011 Mar;96(3):592-9. doi: 10.1210/jc.2010-2329. Epub 2010 Dec 29.
Graves' orbitopathy (GO) is present in about 50% of patients with Graves' hyperthyroidism. It may range from mild to moderately severe and (rarely) to sight-threatening. Whether antithyroid drugs (ATDs), radioactive iodine (RAI), or thyroidectomy should be the treatment of choice in the presence of overt and active GO is a matter of debate.
The major source of data acquisition included PubMed search strategies. Articles published in the last 30 yr were screened. Furthermore, the bibliographies of relevant citations and chapters of major textbooks were evaluated for any additional appropriate citation.
Prompt restoration and stable maintenance of euthyroidism is important for the course of GO. ATDs and thyroidectomy per se do not influence the natural history of GO. RAI can cause progression or de novo development of GO, particularly in smokers. This effect can be prevented by oral steroid prophylaxis. In patients with mild orbitopathy, the choice of thyroid treatment is largely independent of GO. Moderate-to-severe and active GO should be treated without delay. Whether in these patients, concomitant treatment of hyperthyroidism should be conservative (ATDs) or ablative (RAI, thyroidectomy, or both) is presently based on expert opinion rather than evidence. Emerging and potentially interesting biological agents, such as rituximab, counteracting pathogenic mechanisms of both hyperthyroidism and GO, need to be evaluated in randomized clinical trials.
The choice of the optimal treatment for hyperthyroidism in patients with moderate-to-severe and active GO remains unsettled and is mainly based on personal experience. Randomized clinical trials in this field are eagerly needed.
格雷夫斯眼病（GO）存在于约 50%的格雷夫斯甲亢患者中。它可能从轻度到中度严重，（罕见地）到威胁视力。在显性和活跃的 GO 存在的情况下，抗甲状腺药物（ATD）、放射性碘（RAI）还是甲状腺切除术应该是治疗的首选，这是一个有争议的问题。
数据采集的主要来源包括 PubMed 搜索策略。筛选了过去 30 年发表的文章。此外，还评估了相关引文的参考文献和主要教科书的章节，以获取任何其他适当的引文。
迅速恢复和稳定维持甲状腺功能正常对 GO 的病程很重要。ATD 和甲状腺切除术本身并不影响 GO 的自然病程。RAI 可导致 GO 的进展或新发，特别是在吸烟者中。口服类固醇预防可预防这种影响。在轻度眼病患者中，甲状腺治疗的选择在很大程度上与 GO 无关。中度至重度和活跃的 GO 应立即治疗。在这些患者中，是否同时治疗甲亢应保守（ATD）或消融（RAI、甲状腺切除术或两者），目前基于专家意见而不是证据。新兴的、潜在有趣的生物制剂，如利妥昔单抗，可对抗甲亢和 GO 的致病机制，需要在随机临床试验中进行评估。
在中度至重度和活跃的 GO 患者中，治疗甲亢的最佳治疗选择仍未确定，主要基于个人经验。该领域急需随机临床试验。
