Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
Drugs. 2019 Feb;79(2):109-124. doi: 10.1007/s40265-018-1045-9.
Graves' orbitopathy is a debilitating disorder which occurs in patients with autoimmune thyroid disease, mainly Graves' disease, and adds layers of complexity to management of both conditions. We conducted a comprehensive review of literature for publications relating to established and new management options for Graves' orbitopathy and have summarized key articles in this review. Initial evaluation of patients with Graves' disease should also include clinical evaluation for orbitopathy. If eye disease is present, patients are best managed by a multi-specialty team including an endocrinologist and ophthalmologist. All patients with Graves' orbitopathy benefit from risk factor modification and normalization of thyroid function tests. Patients with active, mild disease generally benefit from local therapies and selenium, while patients with moderate-to-severe disease usually require the addition of intravenous glucocorticoid therapy. If there is an inadequate response to glucocorticoid therapy, several second-line therapies have been investigated for use, including orbital radiotherapy (with additional glucocorticoids), rituximab, cyclosporine, mycophenolate mofetil, and methotrexate. Use of new biologic agents, mainly teprotumumab and tocilizumab, have demonstrated impressive reductions in disease activity and severity. If these results are confirmed, the treatment paradigm is likely to change in the future. Finally, there are several novel immunotherapies being investigated for Graves' disease, which may have treatment implications for Graves' orbitopathy as well. Overall, there are many encouraging advances in the therapy of Graves' orbitopathy that are making the future more promising for patients suffering from this disease.
格雷夫斯眼病是一种使人衰弱的疾病，发生于自身免疫性甲状腺疾病患者，主要是格雷夫斯病患者，给这两种疾病的治疗都增加了复杂性。我们对格雷夫斯眼病的既定和新治疗选择的相关文献进行了全面综述，并在本文中总结了关键文章。对格雷夫斯病患者的初始评估也应包括对眼病的临床评估。如果存在眼部疾病，最好由内分泌科医生和眼科医生组成的多学科团队进行治疗。所有格雷夫斯眼病患者均受益于危险因素的改变和甲状腺功能检查的正常化。活动期、轻度疾病的患者通常受益于局部治疗和硒，而中度至重度疾病的患者通常需要添加静脉内糖皮质激素治疗。如果糖皮质激素治疗反应不足，则已经研究了几种二线治疗方法，包括眼眶放射治疗（联合额外的糖皮质激素）、利妥昔单抗、环孢素、霉酚酸酯和甲氨蝶呤。新型生物制剂，主要是替普妥珠单抗和托珠单抗的使用，已显示出对疾病活动度和严重度的显著降低。如果这些结果得到证实，未来的治疗模式可能会发生改变。最后，有几种新型免疫疗法正在研究格雷夫斯病，这可能对格雷夫斯眼病的治疗也有影响。总的来说，格雷夫斯眼病的治疗有许多令人鼓舞的进展，这使得未来患有这种疾病的患者更有希望。
