Bessmertnaya E G, Mikheenkov A A, Kolodina A S, Aksenova T N, Babaeva D M, Grusha Ya O, Sviridenko N Yu
Endocrinology Research Centre.
Research Institute of Eye Diseases.
Probl Endokrinol (Mosk). 2023 Oct 21;70(3):46-54. doi: 10.14341/probl13307.
According to modern concepts, thyroid eye disease (TED) is an independent progressive autoimmune disease of the organ of vision, closely associated with the autoimmune pathology of the thyroid gland (TG), (ICD code - H06.2, proptosis in case of impaired thyroid function E05.0). TED treatment is a long step-by-step process, including immunosuppressive therapy, radiation therapy of the orbits and surgical treatment.TED is a multidisciplinary problem. A patient with thyrotoxicosis clinic and TED symptoms will be taken to an endocrinological clinic for normalization of thyroid hormones and treatment of thyrotoxicosis complications. At the same time, under the supervision of an ophthalmologist, TED diagnostics and treatment will be carried out. Teamwork is of utmost importance because the effectiveness of TED treatment will depend on the speed of achieving a stable euthyroid state, the accuracy of determining the TED activity and severity, and the presence of complications requiring surgical treatment.There are two main phases in the TED development. In the first phase of active inflammation, an increase in the symptoms of TED occurs, then a plateau phase follows, when the symptoms of activity persist but do not progress, then the symptoms regress and the process becomes inactive, while visual disturbances and cosmetic defects may persist. Determining the TED activity is very important from a clinical point of view, because the choice of treatment and tactics of patient management depend on the inflammation activity.We describe a clinical case of phasing treatment of TED complicated by optic neuropathy and movement disorders in a patient with Graves' disease, resistant to immunosuppressive therapy with glucocorticoids and requiring deep lateral bony orbital decompression.
根据现代概念，甲状腺眼病（TED）是一种独立的进行性视觉器官自身免疫性疾病，与甲状腺（TG）的自身免疫病理密切相关（国际疾病分类代码 - H06.2，甲状腺功能受损时突眼为E05.0）。TED的治疗是一个漫长的逐步过程，包括免疫抑制治疗、眼眶放射治疗和手术治疗。TED是一个多学科问题。患有甲状腺毒症临床症状和TED症状的患者将被送往内分泌科诊所，以实现甲状腺激素正常化并治疗甲状腺毒症并发症。同时，在眼科医生的监督下，进行TED的诊断和治疗。团队合作至关重要，因为TED治疗的有效性将取决于实现稳定的甲状腺功能正常状态的速度、确定TED活动和严重程度的准确性以及是否存在需要手术治疗的并发症。TED的发展有两个主要阶段。在活跃炎症的第一阶段，TED症状会加重，随后是平台期，此时活动症状持续但不进展，然后症状消退，病情变得不活跃，而视觉障碍和美容缺陷可能会持续存在。从临床角度来看，确定TED活动非常重要，因为治疗选择和患者管理策略取决于炎症活动。我们描述了一例格雷夫斯病患者TED分期治疗的临床病例，该患者合并视神经病变和运动障碍，对糖皮质激素免疫抑制治疗耐药，需要进行深部外侧眼眶减压术。
