Bartalena Luigi, Piantanida Eliana, Gallo Daniela, Ippolito Silvia, Tanda Maria Laura
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Expert Rev Endocrinol Metab. 2022 Mar;17(2):153-166. doi: 10.1080/17446651.2022.2052044. Epub 2022 Mar 14.
Graves' disease (GD) is an autoimmune disorder due to loss of tolerance to the thyrotropin receptor (TSHR) and ultimately caused by stimulatory TSHR antibodies (TSHR-Ab). GD may be associated with extrathyroidal manifestations, mainly Graves' orbitopathy. Treatment of GD relies on antithyroid drugs (ATDs), radioactive iodine (RAI), thyroidectomy. The major ATD limitation is the high recurrence rate after treatment. The major drawback of RAI and thyroidectomy is the inevitable development of permanent hypothyroidism.
Original articles, clinical trials, systematic reviews, meta-analyses from 1980 to 2021 were searched using the following terms: Graves' disease, management of Graves' disease, antithyroid drugs, radioactive iodine, thyroidectomy, Graves' orbitopathy, thyroid-eye disease.
ATDs are the first-line treatment worldwide, are overall safe and usually given for 18-24 months, long-term treatment may decrease relapses. RAI is safe, although associated with a low risk of GO progression, particularly in smokers. Thyroidectomy requires skilled and high-volume surgeons. Patients play a central role in the choice of treatment within a shared decision-making process. Results from targeted therapies acting on different steps of the autoimmune process, including iscalimab, ATX-GD-59, rituximab, blocking TSHR-Ab, small molecules acting as antagonists of the TSHR, are preliminary or preclinical, but promising in medium-to-long perspective.
格雷夫斯病（GD）是一种自身免疫性疾病，由于对促甲状腺素受体（TSHR）失去耐受性，最终由刺激性TSHR抗体（TSHR-Ab）引起。GD可能与甲状腺外表现有关，主要是格雷夫斯眼病。GD的治疗依赖于抗甲状腺药物（ATD）、放射性碘（RAI）和甲状腺切除术。ATD的主要局限性是治疗后复发率高。RAI和甲状腺切除术的主要缺点是不可避免地会发展为永久性甲状腺功能减退。
使用以下术语检索了1980年至2021年的原始文章、临床试验、系统评价、荟萃分析：格雷夫斯病、格雷夫斯病的管理、抗甲状腺药物、放射性碘、甲状腺切除术、格雷夫斯眼病、甲状腺眼病。
ATD是全球一线治疗方法，总体安全，通常给药18-24个月，长期治疗可能会减少复发。RAI是安全的，尽管与GO进展的低风险相关，尤其是在吸烟者中。甲状腺切除术需要技术熟练且手术量大 的外科医生。在共同决策过程中，患者在治疗选择中起着核心作用。作用于自身免疫过程不同步骤的靶向治疗结果，包括伊斯卡利单抗、ATX-GD-59、利妥昔单抗、阻断TSHR-Ab、作为TSHR拮抗剂的小分子，均为初步或临床前研究结果，但从中长期来看很有前景。
