Wickwar Sadie, McBain Hayley B, Ezra Daniel G, Hirani Shashivadan P, Rose Geoffrey E, Newman Stanton P
1 City University London , School of Health Sciences, London, United Kingdom .
Thyroid. 2014 Sep;24(9):1407-18. doi: 10.1089/thy.2014.0037. Epub 2014 Aug 1.
Thyroid eye disease (TED) causes a number of esthetic and visual problems, and its treatment requires close clinical assessment, often for several years. There is evidence to suggest that clinical factors are poor indicators of patient-reported outcomes after treatments that aim to improve appearance, vision, or both. Psychosocial factors can impact on both adjustment to living with TED and also patients' perceptions of their improvements after treatment. There has been growing recognition that it is essential to evaluate treatment efficacy in terms of psychosocial outcomes, but, to date, there has been no review that has systematically evaluated psychosocial outcomes following a variety of treatments for TED.
Fifteen studies were included in the review, and six were randomized controlled trials. The studies varied greatly in methodological rigor; whilst major treatments such as surgery do improve quality of life outcomes, other noninvasive treatments such as intravenous steroids can have a similar impact and show long-term benefits. Only three studies reviewed orbital decompressive surgery, which showed better psychosocial outcomes than other types of surgery.
The effect of some treatments remains unclear due to poor methodology and poor reporting of results. Clinicians need to be aware when planning rehabilitative treatments such as surgery of the influence of psychosocial factors on quality of life outcomes and the lack of a relationship with clinical factors such as disease severity.
甲状腺眼病（TED）会引发一系列美学和视觉问题，其治疗需要密切的临床评估，通常持续数年。有证据表明，在旨在改善外观、视力或两者的治疗后，临床因素并不能很好地指示患者报告的结果。心理社会因素既会影响患者对TED生活的适应，也会影响患者对治疗后改善情况的认知。人们越来越认识到，从心理社会结果的角度评估治疗效果至关重要，但迄今为止，尚无综述系统地评估过针对TED的各种治疗后的心理社会结果。
该综述纳入了15项研究，其中6项为随机对照试验。这些研究在方法严谨性上差异很大；虽然手术等主要治疗方法确实能改善生活质量结果，但静脉注射类固醇等其他非侵入性治疗也能产生类似影响并显示出长期益处。仅有3项研究对眼眶减压手术进行了综述，结果显示其心理社会结果优于其他类型的手术。
由于方法欠佳和结果报告不充分，一些治疗的效果仍不明确。临床医生在计划诸如手术等康复治疗时，需要意识到心理社会因素对生活质量结果的影响，以及与疾病严重程度等临床因素缺乏关联。
