Unidad de Enfermedades Sistémicas Autoinmunes y Minoritarias, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España.
CSUR de tumores orbitarios y cirugía de descompresión orbitaria en Oftalmopatía Tiroidea. Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, España.
Med Clin (Barc). 2021 Feb 26;156(4):180-186. doi: 10.1016/j.medcli.2020.07.031. Epub 2020 Oct 14.
Graves' ophthalmopathy is an inflammatory disease with primary involvement of the extraocular muscles and the orbit. It encompasses the most common extra-thyroid manifestation in patients with Graves-Basedow disease. The underlying cause is molecular mimicry with the TSH receptor in ocular fibroblasts, leading to an immuno-mediated pathogenesis. Glucocorticoids at high doses are the cornerstone in moderate-severe cases. However, some patients are corticorresistant or intolerant. In recent years, therapeutic novelties have been described in terms of the dosage of the immunosuppressive treatments used, as well as the emergence of biological therapy in this field. The objective of this review is to update the treatment of Graves' ophthalmopathy, as well as to present alternative options in patients resistant or intolerant to glucocorticoids.
格雷夫斯眼病是一种炎症性疾病，主要累及眼外肌和眼眶。它是格雷夫斯病患者最常见的甲状腺外表现。其根本原因是眼成纤维细胞中的 TSH 受体与某些分子发生类似，导致免疫介导的发病机制。对于中重度病例，大剂量糖皮质激素是基石。然而，一些患者对糖皮质激素抵抗或不耐受。近年来，在免疫抑制治疗的剂量方面以及在该领域出现生物疗法方面，已有治疗新方法被描述。本综述的目的是更新格雷夫斯眼病的治疗方法，并介绍对糖皮质激素抵抗或不耐受的患者的替代选择。
