University of Southern Denmark, Odense, Denmark.
Best Pract Res Clin Endocrinol Metab. 2012 Jun;26(3):313-24. doi: 10.1016/j.beem.2011.09.005.
The etiology of Graves' orbitopathy (GO) remains enigmatic. Optimal therapeutic choices for the hyperthyroidism associated with Graves' disease (GD) in the presence of GO remain controversial. Whether antithyroid drugs (ATDs), radioiodine (RAI), or thyroidectomy should be favored in such patients remains debated. Pre-therapy variables such as ethnicity, sex, age, thyroid function, level of TSH-receptor antibodies and smoking behavior influence response to therapy. Among the most important management goals are restoring euthyroidism and abstaining from smoking. On average, ATDs and thyroidectomy - independent of extent - do not influence the natural course of GO. RAI can cause de novo development or progression of GO, which is largely preventable with oral steroid prophylaxis. In patients with mild GO, the thyroid treatment is largely independent of GO. Moderate to severe GO should be treated promptly. Deciding whether, in the latter, GD is better treated with ATDs, RAI, or surgery, is based more on expert opinion than on evidence. It is clear that in the individual patient a number of factors, not addressed in any trial, influence the final choice of therapy for GD, including concern of developing or negatively affecting pre-existing GO. Evidently, there is room for improving therapy of GO. Progress using novel drugs such as rituximab, which might potentially influence positively both GD and GO, are impatiently awaited.
格雷夫斯眼病（GO）的病因仍然是个谜。对于伴有 GO 的格雷夫斯病（GD）患者，甲状腺功能亢进的最佳治疗选择仍存在争议。在这些患者中，是否应该优先选择抗甲状腺药物（ATD）、放射性碘（RAI）还是甲状腺切除术仍存在争议。治疗前的变量，如种族、性别、年龄、甲状腺功能、促甲状腺激素受体抗体水平和吸烟行为，会影响治疗反应。最重要的管理目标之一是恢复甲状腺功能正常并戒除吸烟。平均而言，ATD 和甲状腺切除术——无论范围如何——都不会影响 GO 的自然病程。RAI 可导致 GO 的新发或进展，这在很大程度上可以通过口服类固醇预防来预防。对于轻度 GO 患者，甲状腺治疗在很大程度上与 GO 无关。对于中度至重度 GO，应立即进行治疗。对于后者，是选择 ATD、RAI 还是手术治疗 GD，更多的是基于专家意见而不是证据。很明显，在个体患者中，许多在任何试验中都未涉及的因素会影响 GD 治疗的最终选择，包括对发生或对先前存在的 GO 产生负面影响的担忧。显然，GO 的治疗还有改进的空间。人们急切地期待着使用利妥昔单抗等新型药物来治疗 GO，这些药物可能会对 GD 和 GO 产生积极影响。
