Department of Clinical and Experimental Medicine, Endocrinology Unit II, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
Department of Surgical, Medical and Molecular Pathology, Ophthalmopathy Unit I, University of Pisa and University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
J Endocrinol Invest. 2021 Dec;44(12):2575-2579. doi: 10.1007/s40618-021-01544-1. Epub 2021 Apr 12.
Graves' orbitopathy (GO) reflects an autoimmune response against antigens expressed by the thyroid and orbital tissues. Elimination of thyroid antigens may be beneficial for GO. Total thyroid ablation (TTA) [thyroidectomy (Tx), followed by 30 mCi of radioiodine] was shown to exert a beneficial effect on GO following intravenous glucocorticoids (ivGC) compared with Tx alone. Here, we investigated retrospectively whether TTA performed with a 15 mCi of radioiodine still maintains advantages over Tx.
Thirty-two subjects, 13 treated with TTA (performed with 15 mCi of radioiodine) and 19 with Tx alone, all with moderately severe, active GO, treated with ivGC, were studied. The primary objective was the outcome of GO at 24 weeks based on a composite evaluation.
The two groups did not differ at baseline in terms of sex, age, smoking habits, TSH, anti-TSH receptor autoantibodies, GO duration and eye features. The proportion of GO responders at 24 weeks was greater in the TTA (61.5%) than in the Tx group (26.3%, P = 0.046). In contrast, GO outcome at 48 weeks did not differ between the two groups (69.2% vs 52.6% of responder in TTA and Tx group, respectively). The outcome of the individual GO features did not differ between the two groups both a 24 and 48 months.
The advantage of total thyroid ablation seems to be a more rapid response for GO to ivGC treatment. Prospective, randomized studies in a larger number of subjects are needed to confirm our findings.
格雷夫斯眼病（GO）反映了针对甲状腺和眼眶组织表达的抗原的自身免疫反应。消除甲状腺抗原可能对 GO 有益。与单独甲状腺切除术（Tx）相比，静脉内糖皮质激素（ivGC）治疗后，全甲状腺消融（TTA）[甲状腺切除术（Tx），随后给予 30 mCi 放射性碘]对 GO 显示出有益作用。在这里，我们回顾性研究了用 15 mCi 放射性碘进行的 TTA 是否仍优于 Tx。
研究了 32 名患者，其中 13 名接受 TTA（用 15 mCi 放射性碘进行）治疗，19 名单独接受 Tx 治疗，所有患者均患有中度严重、活动性 GO，并接受 ivGC 治疗。主要目的是根据综合评估，在 24 周时评估 GO 的结局。
两组在性别、年龄、吸烟习惯、TSH、抗 TSH 受体自身抗体、GO 持续时间和眼部特征方面在基线时没有差异。在 24 周时，TTA 组（61.5%）GO 反应者的比例大于 Tx 组（26.3%，P=0.046）。相比之下，两组在 48 周时 GO 的结局没有差异（TTA 和 Tx 组分别有 69.2%和 52.6%的反应者）。两组在 24 和 48 个月时的个别 GO 特征的结局没有差异。
全甲状腺消融的优势似乎是对 ivGC 治疗的 GO 更快的反应。需要更多的前瞻性、随机研究来证实我们的发现。
