Ito Hospital (N.W., J.Y.N., K.I., K.S., Y.K., M.M., M.S., A.Y., H.O., S.K., Y.K., K.M., K.S., K.I.), Tokyo, Japan 150-8308; and Olympia Eye Hospital (A.K., T.I.), Tokyo, Japan 150-0001.
J Clin Endocrinol Metab. 2015 Jul;100(7):2700-8. doi: 10.1210/jc.2014-4542. Epub 2015 May 12.
Exacerbation of Graves' orbitopathy (GO) after radioiodine (RAI) therapy has been examined in some populations but has not been fully described in Japanese populations.
The purpose of this study was to clarify the characteristics of GO exacerbation after RAI therapy and the effectiveness of low-dose prophylactic corticosteroid (PCS).
This was a prospective randomized study in Tokyo, Japan.
Between June 2011 and June 2012, 295 patients with Graves' disease with either inactive GO or no GO received RAI therapy. Of these, 147 received no PCS (PCS-Off group), whereas 148 received low-dose PCS (starting dose, 15 mg/day of prednisolone) for 6 weeks (PCS-On group). We used magnetic resonance imaging to thoroughly evaluate GO before and 1 year after RAI therapy.
Outcomes of GO 1 year after RAI therapy were determined.
GO exacerbation occurred in 29 patients (9.8%), and only 7 patients (2.4%) required ophthalmic treatment. No significant difference in the frequency of GO exacerbation was seen between the groups (PCS-On group: n = 18 [12.1%]; PCS-Off group: n = 11 [7.5%]; P = .17). Significant prognostic factors were identified as thyroid-stimulating antibody (by 100% linear increase: risk ratio, 1.15; 95% confidence interval, 1.07-1.24; P = .0003) and clinical activity score (≥1 vs 0: risk ratio, 6.40; 95% confidence interval, 2.17-19.7; P = .0009).
Exacerbation of GO after RAI therapy in the Japanese population appears less common than in other populations. Low-dose PCS did not produce a significant preventive effect and appeared insufficient. Patients presenting with risk factors would thus be recommended to receive higher-dose PCS.
放射性碘（RAI）治疗后 Graves 眼病（GO）的加重已在一些人群中进行了研究，但在日本人群中尚未得到充分描述。
本研究旨在阐明 RAI 治疗后 GO 加重的特征以及低剂量预防性皮质类固醇（PCS）的疗效。
这是一项在日本东京进行的前瞻性随机研究。
2011 年 6 月至 2012 年 6 月期间，295 例患有 Graves 病的患者，无论 GO 是否活跃或无 GO，均接受 RAI 治疗。其中，147 例未接受 PCS（PCS-Off 组），而 148 例接受低剂量 PCS（起始剂量为 15mg/天泼尼松龙）治疗 6 周（PCS-On 组）。我们使用磁共振成像（MRI）在 RAI 治疗前后对 GO 进行了全面评估。
确定 RAI 治疗 1 年后 GO 的结果。
29 例（9.8%）患者出现 GO 加重，仅 7 例（2.4%）患者需要眼部治疗。两组间 GO 加重的频率无显著差异（PCS-On 组：18 例[12.1%]；PCS-Off 组：11 例[7.5%]；P=.17）。确定的显著预后因素包括甲状腺刺激抗体（线性增加 100%：风险比 1.15；95%置信区间 1.07-1.24；P=.0003）和临床活动评分（≥1 与 0：风险比 6.40；95%置信区间 2.17-19.7；P=.0009）。
与其他人群相比，日本人群 RAI 治疗后 GO 的加重似乎较少见。低剂量 PCS 并未产生显著的预防作用，且似乎不足。因此，建议具有危险因素的患者接受更高剂量的 PCS。
Zotero 插件