Serviço de Endocrinologia, Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Av Professor Alfredo Balena 190, Belo Horizonte, MG, Brazil.
Serviço de Endocrinologia, Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Av Professor Alfredo Balena 190, Belo Horizonte, MG, Brazil.
Ann Endocrinol (Paris). 2024 Dec;85(6):582-588. doi: 10.1016/j.ando.2024.09.001. Epub 2024 Sep 20.
INTRODUCTION/OBJECTIVE: Active moderate-to-severe thyroid eye disease (TED) is a major therapeutic challenge. Pulse therapy with intravenous glucocorticoids is the standard treatment, with variable response. Radioactive iodine therapy (RAI) was reported as a risk factor for onset or worsening of TED. We evaluated putative predictive factors for response to intravenous methylprednisolone in patients with active TED.
Data were collected for 64 consecutive patients (45 women) with active moderate-to-severe TED treated with a minimum cumulative dose of 4.5g methylprednisolone. Patients were classified as responders (R) or non-responders (NR) on Clinical Activity Score (CAS), and clinical features were compared between groups.
Sixty-two patients had Graves' disease (GD), and 2 had Hashimoto's thyroiditis (HT). Median age at thyroid dysfunction diagnosis, TED manifestation and pulse therapy was 46, 48 and 51 years, respectively; 56.2% were euthyroid when TED manifested. Among them, 73.4% were responders. R and NR were comparable for gender, age, thyroid function, serum antibodies, disease duration, pre-treatment CAS, smoking, lipid profile, and adverse events. Forty-nine patients were treated with RAI for GD: 15 before the active phase of TED (before pulse therapy), 16 during, 17 after, and 1 both before and after pulse therapy. Response rate was higher in patients who received RAI during than after pulse therapy (P=0.032) and similar to those not treated with RAI at all (P=0,599).
Pulse therapy was effective in the majority of patients. The only factor associated with response to pulse therapy was the timing of RAI, suggesting that it seems to be safe when used concomitantly with pulse therapy.
简介/目的：活动性中重度甲状腺眼病（TED）是一个主要的治疗挑战。静脉注射糖皮质激素脉冲治疗是标准治疗方法，但反应不一。放射性碘治疗（RAI）被报道为 TED 发病或加重的危险因素。我们评估了活动性 TED 患者静脉注射甲泼尼龙治疗反应的潜在预测因素。
收集了 64 例（45 名女性）活动性中重度 TED 患者的数据，这些患者接受了至少 4.5g 甲泼尼龙的累积剂量治疗。根据临床活动评分（CAS）将患者分为应答者（R）或无应答者（NR），并比较两组之间的临床特征。
62 例患者患有格雷夫斯病（GD），2 例患有桥本甲状腺炎（HT）。甲状腺功能障碍诊断、TED 表现和脉冲治疗的中位年龄分别为 46、48 和 51 岁；56.2%的患者 TED 表现时处于甲状腺功能正常状态。其中，73.4%的患者是应答者。R 和 NR 在性别、年龄、甲状腺功能、血清抗体、疾病持续时间、治疗前 CAS、吸烟、血脂谱和不良事件方面无差异。49 例 GD 患者接受了 RAI 治疗：15 例在 TED 活动期之前（脉冲治疗前），16 例在活动期，17 例在活动期后，1 例在脉冲治疗前后。在脉冲治疗期间接受 RAI 治疗的患者的应答率高于治疗后的患者（P=0.032），与根本未接受 RAI 治疗的患者相似（P=0.599）。
脉冲治疗对大多数患者有效。唯一与脉冲治疗反应相关的因素是 RAI 的时间，这表明在与脉冲治疗同时使用时似乎是安全的。
