Urselli Francesca, Pontieri Gilda, Peschi Livia, Liccardi Alessia, Ruggiero Anna Rita, Biondi Bernadette
Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Front Endocrinol (Lausanne). 2019 Jan 17;9:810. doi: 10.3389/fendo.2018.00810. eCollection 2018.
Graves' orbitopathy (GO) is the main extrathyroidal manifestation of Graves' disease (GD). Diabetes mellitus (DM) has been reported to be a risk factor in patients with GO. Moreover, GO can be more frequent and severe in type 2 diabetes patients. High doses of intravenous glucocorticoids represent the first line treatment of moderate-to-severe and active GO according to the international guidelines. However, this therapy is contraindicated in uncontrolled diabetes and in patients with increased cardiovascular risk. Some anti-diabetic drugs can exacerbate GO. We reported the clinical case of an active and moderate-to-severe GO in a patient with uncontrolled type 2 DM and vascular complications. A 61-years-old patient came to our ambulatory for a recurrence of GD and a moderate-to-severe bilateral GO. The patient had uncontrolled type 2 DM during insulin therapy and a history of micro and macrovascular complications. At the physical examination, the clinical activity score was 5 and the severity of GO was moderate-to-severe. A blood sample showed overt hyperthyroidism and the persistence of anti-TSH receptor antibodies (TRAb) during treatment with methimazole. A computed tomography scan showed a moderate-to-severe bilateral exophthalmos. We discuss the benefit/risk of treatment of GO in our patient. The available guidelines do not focus on the treatment of diabetic patients with uncontrolled diabetes and severe vascular complications, therefore our patient represents a difficult therapeutic challenge. The screening of thyroid function and the evaluation of GO could be useful in diabetic patients with autoimmune thyroid disease to perform a correct treatment of these disorders.
格雷夫斯眼眶病（GO）是格雷夫斯病（GD）的主要甲状腺外表现。据报道，糖尿病（DM）是GO患者的一个危险因素。此外，2型糖尿病患者中GO可能更常见且更严重。根据国际指南，高剂量静脉注射糖皮质激素是中度至重度活动性GO的一线治疗方法。然而，这种疗法在未控制的糖尿病患者和心血管风险增加的患者中是禁忌的。一些抗糖尿病药物会加重GO。我们报告了一例未控制的2型糖尿病合并血管并发症患者出现活动性中度至重度GO的临床病例。一名61岁患者因GD复发和中度至重度双侧GO前来我们的门诊。该患者在胰岛素治疗期间患有未控制的2型糖尿病，并有微血管和大血管并发症史。体格检查时，临床活动评分为5分，GO严重程度为中度至重度。血液样本显示明显的甲状腺功能亢进，在使用甲巯咪唑治疗期间抗促甲状腺激素受体抗体（TRAb）持续存在。计算机断层扫描显示中度至重度双侧眼球突出。我们讨论了对该患者GO治疗的获益/风险。现有的指南未关注未控制糖尿病和严重血管并发症的糖尿病患者的治疗，因此我们的患者代表了一个艰难的治疗挑战。对自身免疫性甲状腺疾病的糖尿病患者进行甲状腺功能筛查和GO评估，可能有助于对这些疾病进行正确治疗。
