Department of Endocrinology and Metabolism, University of Pisa, 56127 Pisa, Italy.
Best Pract Res Clin Endocrinol Metab. 2012 Jun;26(3):325-37. doi: 10.1016/j.beem.2011.11.005.
Treatment of Graves' orbitopathy (GO) is better performed through a multidisciplinary approach. Euthyroidism should be promptly restored. Antithyroid drug and thyroidectomy are not disease-modifying treatments, whereas radioiodine may be associated with worsening of GO. This risk is eliminated by glucocorticoid prophylaxis. Treatments for GO differ depending on its severity and activity. Mild forms should be treated with local measures. In addition a course of selenium may be beneficial. Glucocorticoids (oral or intravenous) represent the main treatment of moderate-to-severe GO, the intravenous route being more effective. Weekly pulses of methylprednisolone are used and the cumulative dose should not exceed 8 g. Severe adverse events have been reported, particularly with higher doses. Orbital radiotherapy can be used either alone or associated with glucocorticoids. In very severe sight-threatening GO high dose intravenous glucocorticoid should be the initial treatment, orbital decompression being considered in nonresponding patients. Rehabilitative surgery should be deferred until GO becomes inactive.
格雷夫斯眼病（GO）的治疗采用多学科方法效果更好。应尽快恢复甲状腺功能正常。抗甲状腺药物和甲状腺切除术不是疾病修正治疗，而放射性碘治疗可能会使 GO 恶化。这种风险可以通过糖皮质激素预防来消除。GO 的治疗取决于其严重程度和活动度。轻度应采用局部治疗。此外，硒治疗可能有益。糖皮质激素（口服或静脉注射）是中重度 GO 的主要治疗方法，静脉途径更有效。每周给予甲泼尼龙脉冲治疗，累积剂量不应超过 8 克。已有严重不良反应报告，特别是在使用更高剂量时。眼眶放射治疗可单独使用或与糖皮质激素联合使用。在严重威胁视力的 GO 中，高剂量静脉内糖皮质激素应作为初始治疗，对无反应的患者应考虑眶减压术。康复手术应在 GO 处于非活动期后进行。
