Hall Anthony J H, Topliss Duncan J
Department of Ophthalmology, The Alfred, Melbourne, Victoria, Australia.
Department of Surgery, Monash University, Melbourne, Victoria, Australia.
Intern Med J. 2022 Jan;52(1):14-20. doi: 10.1111/imj.15067.
Thyroid eye disease is an autoimmune inflammatory disease strongly associated with thyroid disease, principally Graves disease. It can range from mild disease requiring observation or symptomatic treatments only, through to sight-threatening disease requiring major drug therapy and orbital surgery. Severity is graded by the NOSPECS system and activity by the clinical activity score (CAS) to assist in treatment selection. Non-surgical management can extend from observation alone to minor therapy such as oral selenium, then glucocorticoid therapy, cyclosporin, mycophenolate, rituximab, immunoglobulin, teprotumumab, and orbital radiotherapy. High-dose intravenous methylprednisolone therapy is used in active vision-threatening disease with early use of tarsorrhaphy and orbital decompression. Inactive but moderate to severe disease may be treated by orbital decompression, strabismus and eyelid surgery. Systematic assessment and management by both an endocrinologist and ophthalmologist to achieve and maintain euthyroidism and select and sequence treatments according to activity and severity of thyroid eye disease gives the best results for quality of life and vision.
甲状腺眼病是一种与甲状腺疾病密切相关的自身免疫性炎症性疾病，主要与格雷夫斯病相关。其病情范围可从仅需观察或对症治疗的轻症，到需要主要药物治疗和眼眶手术的威胁视力的疾病。病情严重程度通过NOSPECS系统分级，活动度通过临床活动评分（CAS）分级，以协助治疗选择。非手术治疗可从单纯观察到如口服硒等轻度治疗，然后是糖皮质激素治疗、环孢素、霉酚酸酯、利妥昔单抗、免疫球蛋白、替普罗单抗和眼眶放射治疗。高剂量静脉注射甲泼尼龙治疗用于有威胁视力的活动性疾病，并早期使用睑裂缝合术和眼眶减压术。非活动性但中度至重度疾病可通过眼眶减压术、斜视和眼睑手术治疗。内分泌科医生和眼科医生进行系统评估和管理，以实现并维持甲状腺功能正常，并根据甲状腺眼病的活动度和严重程度选择治疗方法并安排治疗顺序，这样才能在生活质量和视力方面取得最佳效果。
