Meyer Zu Horste M, Pateronis K, Walz M K, Alesina P, Mann K, Schott M, Esser J, Eckstein A K
Center for Ophthalmology, Department of Neuroophthalmology and Strabismus, University of Duisburg-Essen, Essen, Germany.
Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
Horm Metab Res. 2016 Jul;48(7):433-439. doi: 10.1055/s-0042-108855. Epub 2016 Jun 28.
The aim of the work was to investigate the effect of early thyroidectomy on the course of active Graves' orbitopathy (GO) in patients with low probability of remission [high TSH receptor antibody (TRAb) serum levels, severe GO] compared to that of continued therapy with antithyroid drugs. Two cohorts were evaluated retrospectively (total n=92 patients with active GO, CAS≥4). Forty-six patients underwent early thyroidectomy (Tx-group) 6±2 months after initiation of antithyroid drug (ATD) therapy, while ATD was continued for another 6±2 months in the ATD-group (n=46). These controls were consecutively chosen from a database and matched to the Tx-group. GO was evaluated (activity, severity, TRAb) at baseline and at 6 month follow-up. At baseline, both cohorts were virtually identical as to disease severity, activity and duration, as well as prior anti-inflammatory treatment, age, gender, and smoking behavior. At 6 month follow-up, NOSPECS severity score was significantly decreased within each group, but did not differ between both groups. However, significantly more patients of the Tx-group presented with inactive GO (89.1 vs. 67.4%, * p=0.02), and mean CAS score was significantly lower in Tx-group (2.1) than in ADT-group (2.8; * p=0.02) at the end of follow-up. TRAb levels declined in both groups (Tx-group: from 18.6 to 5.2 vs. ATD-group: 12.8-3.2 IU/l, p0=0.07, p6months=0.32). Residual GO activity was lower in Tx-group, associated with a higher rate of inactivation of GO. This allows an earlier initiation of ophthalmosurgical rehabilitation in patients with severe GO, which may positively influence quality of life of the patients.
这项研究的目的是，与继续使用抗甲状腺药物治疗相比，探讨早期甲状腺切除术对缓解可能性较低（促甲状腺激素受体抗体血清水平高、严重Graves眼病）的活动性Graves眼病（GO）患者病程的影响。对两个队列进行回顾性评估（共92例活动性GO患者，临床活动评分≥4）。46例患者在开始抗甲状腺药物（ATD）治疗6±2个月后接受早期甲状腺切除术（Tx组），而ATD组（n = 46）继续使用ATD治疗另外6±2个月。这些对照组是从数据库中连续选取并与Tx组匹配的。在基线和6个月随访时评估GO（活动度、严重程度、促甲状腺激素受体抗体）。在基线时，两个队列在疾病严重程度、活动度、病程以及既往抗炎治疗、年龄、性别和吸烟行为方面几乎相同。在6个月随访时，每组内NOSPECS严重程度评分均显著降低，但两组之间无差异。然而，Tx组中更多患者的GO转为非活动性（89.1%对67.4%，*p = 0.02），随访结束时Tx组的平均临床活动评分（2.1）显著低于ATD组（2.8；*p = 0.02）。两组促甲状腺激素受体抗体水平均下降（Tx组：从18.6降至5.2，而ATD组：从12.8降至3.2 IU/l，p0 = 0.07，p6个月 = 0.32）。Tx组的残余GO活动度较低，与GO失活率较高相关。这使得严重GO患者能够更早开始眼科手术康复，这可能对患者的生活质量产生积极影响。
