Sridama V, DeGroot L J
Department of Medicine, University of Chicago, Illinois.
Am J Med. 1989 Jul;87(1):70-3. doi: 10.1016/s0002-9343(89)80485-1.
Contradictory results have been obtained with regards to the effect of various treatment modes on the exacerbation of Graves' ophthalmopathy, probably because the number of patients in each study was small and some studies were analyzed only in relation to one type of treatment. To circument these problems, we studied the course of Graves' ophthalmopathy after various modes of therapy for thyrotoxicosis among 537 patients with Graves' disease.
A total of 537 patients with Graves' disease were prospectively studied over an 11-year period. Thirty-one patients were lost to follow-up during the first six months after treatment and were excluded from the study. Of those remaining, 426 received one form of treatment, 79 received two kinds of therapy, and one received three kinds of therapy. Thus, surgical treatments numbered 164, radioactive iodine-131 (131I) treatments numbered 241, and medical treatments numbered 182. Ocular signs were considered improved or exacerbated by the following criteria: decrement or increment of the exophthalmos of 2 mm or more, improvement or deterioration of visual acuity, and regression or progression of extraocular muscle involvement causing diplopia.
Among patients who did not have infiltrative ophthalmopathy before treatment, there was no difference in the occurrence of posttreatment exophthalmos in the surgically, medically, and 131I-treated patients (7.1%, 6.7%, and 4.9%, respectively). The incidence and the degree of progression of ophthalmopathy in patients who already had exophthalmos before treatment were similar in the medically, surgically, and 131I-treated groups (19.2%, 19.8%, and 22.7%, respectively). Most of the progression occurred in the posttreatment euthyroid stage. The incidence of improvement of ophthalmopathy was also similar (14.1%, 12.6%, and 12.3% in the medically, surgically, and 131I-treated patients).
In conclusion, we found no influence of type of therapy for thyrotoxicosis on the clinical course of Graves' ophthalmopathy in this retrospective study of 537 patients.
关于各种治疗方式对格雷夫斯眼病恶化的影响，已得出相互矛盾的结果，这可能是因为每项研究中的患者数量较少，且一些研究仅针对一种治疗类型进行分析。为解决这些问题，我们研究了537例格雷夫斯病患者在采用各种方式治疗甲状腺毒症后格雷夫斯眼病的病程。
在11年期间对总共537例格雷夫斯病患者进行前瞻性研究。31例患者在治疗后的前六个月失访，被排除在研究之外。在其余患者中，426例接受了一种治疗方式，79例接受了两种治疗，1例接受了三种治疗。因此，手术治疗164例，放射性碘 - 131（131I）治疗241例，药物治疗182例。眼部体征根据以下标准判断为改善或恶化：眼球突出度减少或增加2毫米或更多、视力改善或恶化、以及导致复视的眼外肌受累情况的消退或进展。
在治疗前没有浸润性眼病的患者中，手术治疗、药物治疗和131I治疗的患者治疗后眼球突出的发生率没有差异（分别为7.1%、6.7%和4.9%）。治疗前已有眼球突出的患者中，眼病进展的发生率和程度在药物治疗组、手术治疗组和131I治疗组中相似（分别为19.2%、19.8%和22.7%）。大多数进展发生在治疗后的甲状腺功能正常阶段。眼病改善的发生率也相似（药物治疗、手术治疗和131I治疗的患者分别为14.1%、12.6%和12.3%）。
总之，在这项对537例患者的回顾性研究中，我们发现甲状腺毒症的治疗方式对格雷夫斯眼病的临床病程没有影响。
