Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, viale Borri, 57, 21100 Varese, Italy.
Best Pract Res Clin Endocrinol Metab. 2012 Jun;26(3):371-9. doi: 10.1016/j.beem.2011.09.004.
Smoking is the most important risk factor for the occurrence/progression of Graves' ophthalmopathy (GO), as well as for its lower/slower response to immunosuppression. Accordingly, refrain from smoking should be urged, both as primary prevention (removal of risk factors in Graves' patients without GO), secondary prevention (early detection and treatment of asymptomatic/very mild GO) and tertiary prevention (reduction of complications/disability of overt GO). A 6-month course of 200 μg/day sodium selenite can prevent progression of mild GO to more severe GO and is, therefore, a form of secondary prevention and, probably, primary prevention. Correction of thyroid dysfunction and stable maintenance of euthyroidism are important preventive measures. The optimal treatment for hyperthyroidism in patients with GO is uncertain, because evidence demonstrating the superiority of antithyroid drugs over thyroid ablation (radioiodine, thyroidectomy, or both) is lacking. If radioiodine is used, low-dose steroid prophylaxis is recommended, particularly in smokers, to prevent radioiodine-associated GO progression.
吸烟是格雷夫斯眼病（GO）发生/进展的最重要危险因素，也是其对免疫抑制反应较低/较慢的原因。因此，应敦促戒烟，包括作为一级预防（去除无 GO 的格雷夫斯病患者的危险因素）、二级预防（早期发现和治疗无症状/非常轻度 GO）和三级预防（减少明显 GO 的并发症/残疾）。6 个月的 200μg/天亚硒酸钠疗程可预防轻度 GO 进展为更严重的 GO，因此是二级预防，可能也是一级预防。纠正甲状腺功能障碍和稳定维持甲状腺功能正常是重要的预防措施。GO 患者的甲亢最佳治疗方法尚不确定，因为缺乏证据表明抗甲状腺药物优于甲状腺消融（放射性碘、甲状腺切除术或两者）。如果使用放射性碘，建议进行低剂量类固醇预防，特别是在吸烟者中，以预防放射性碘相关 GO 进展。
