Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Via Pansini N. 5, 80131 Naples, Italy.
Endocrine. 2012 Apr;41(2):320-6. doi: 10.1007/s12020-011-9559-x. Epub 2011 Nov 16.
The findings in hyperthyroid patients with Graves' orbitopathy (GO) of antibodies against antigens shared between the thyroid and orbit, such as the TSH-receptor (TRAb) and a novel protein G2s (G2sAb), suggested a possible common therapeutic strategy. However, the gold therapeutic standard for hyperthyrodism in these patients remains still unsettled and is mainly based on personal experience. Studies on the effect of total thyroidectomy (TT) alone or followed by radioiodine ablation (RAI) of thyroid remnants showed often conflicting results. This longitudinal study was aimed at evaluating the influence of TT alone or followed by post-surgical RAI with respect to methimazole treatment on the activity and severity of GO in patients with hyperthyroidism and GO. Sixty consecutive patients with Graves' disease and mild/moderate GO were studied and grouped as follows: group 1, including 25 patients (16F, 9M) undergoing TT alone; group 2, including 10 patients (8F, 2M) undergoing TT followed by RAI for histological evidence of differentiated thyroid cancer; group 3, including 25 patients (18F, 7M) euthyroid under methimazole therapy, studied as controls. Clinical study of ophthalmopathy and measurements of TRAb and G2sAb were performed in all patients at start of the study (time of TT for group 1 and RAI after TT for group 2 and of the first finding of euthyroidism under methimazole treatment for group 3) and after 6, 12, 24 months. Patients of both groups 1 and 2 showed an early significant decrease and a further progressive reduction of the activity and severity of GO with a disappearance of TRAb and a decrease of G2sAb levels during the follow-up, without statistically significant differences between the two groups. Patients in group 3 showed a much later and less marked improvement of GO with persistence of TRAb and G2sAb positivity, even if with reduction of TRAb levels at 12 and 24 months. Our results suggest that in Graves' patients with large goiter or relapse of hyperthyroidism and mild/moderate GO, TT alone could be an advisable choice to treat hyperthyroidism also improving GO with reduction of cost/benefit ratio.
在 Graves 眼病（GO）伴甲状腺功能亢进症（甲亢）患者中发现针对甲状腺和眼眶之间共同抗原的抗体，如促甲状腺激素受体（TRAb）和新型蛋白 G2s（G2sAb），提示可能存在共同的治疗策略。然而，这些患者甲亢的黄金治疗标准仍然没有定论，主要是基于个人经验。关于单纯甲状腺全切除术（TT）或随后进行甲状腺残留组织放射性碘消融（RAI）的研究结果常常相互矛盾。这项纵向研究旨在评估 TT 单独或随后进行术后 RAI 对甲亢伴 GO 患者 GO 的活动度和严重程度的影响。连续 60 例 Graves 病和轻度/中度 GO 患者入组并分组如下：1 组 25 例（16 例女性，9 例男性）行 TT 单独治疗；2 组 10 例（8 例女性，2 例男性）行 TT 联合术后 RAI 治疗分化型甲状腺癌的组织学证据；3 组 25 例（18 例女性，7 例男性）在接受甲巯咪唑治疗时处于甲状腺功能正常状态，作为对照组。所有患者在研究开始时（1 组 TT 时、2 组 TT 后 RAI 时和 3 组首次发现甲巯咪唑治疗下甲状腺功能正常时）和 6、12、24 个月时进行眼病临床研究和 TRAb 和 G2sAb 测量。1 组和 2 组患者的 GO 活动度和严重度均在早期显著下降，随后进一步逐渐减轻，TRA b 和 G2sAb 水平下降，随访期间两组间无统计学差异。3 组患者 GO 改善较晚且不明显，TRA b 和 G2sAb 阳性持续存在，即使 TRAb 水平在 12 和 24 个月时降低。我们的结果表明，对于大甲状腺肿或甲亢复发伴轻度/中度 GO 的 Graves 病患者，TT 单独治疗可能是一种可行的选择，既能治疗甲亢，又能改善 GO，降低成本/效益比。
