Cosentino Giada, Lanzolla Giulia, Comi Simone, Maglionico Maria Novella, Posarelli Chiara, Ciampa Dalì Antonia, Menconi Francesca, Rocchi Roberto, Latrofa Francesco, Figus Michele, Santini Ferruccio, Marinò Michele
Department of Clinical and Experimental Medicine, Endocrinology Units, University of Pisa and University Hospital of Pisa, Pisa, Italy.
Department of Surgical, Medical and Molecular Pathology, Ophthalmopathy Unit I, University of Pisa and University Hospital of Pisa, Pisa, Italy.
Thyroid. 2025 Mar;35(3):298-306. doi: 10.1089/thy.2024.0633. Epub 2025 Feb 5.
Treatment for Graves' hyperthyroidism (GH) in patients with Graves' orbitopathy (GO) remains a topic of debate. This study aimed to investigate the outcome of GO following glucocorticoids, depending on the chosen thyroid treatment. This retrospective cohort study included 49 consecutive patients with GH and moderate-to-severe, active GO, as defined by the European Group on Graves' Orbitopathy guidelines. Twenty-four patients were treated with radioactive iodine (RAI) and 25 with methimazole (MMI). All patients were administered intravenous methylprednisolone. Follow-up visits occurred at weeks 24, 48, and 72. The primary endpoint was the overall outcome of GO at week 24. Response was defined as a change in at least two of the following eye features: reduction ≥1 point in clinical activity score; proptosis reduction ≥2 mm; eyelid aperture reduction ≥2 mm; increase in eye ductions ≥8 degrees. Follow-up duration was 72 weeks for both groups (interquartile range 66-72 for RAI and 48-72 for MMI). The proportion of responders for week 24 overall GO outcome was greater in RAI (54.1% vs. 16%; odds ratio [OR] 6.2 [confidence interval (CI): 1.6-23.6], = 0.0075), but it increased in MMI at weeks 48 and 72, with no differences between groups. There was a trend indicating a better response in RAI regarding individual eye features. Improvement in GO-specific quality of life questionnaire at week 24 was trendily more pronounced in RAI (responders 50% vs. 28% in MMI; OR = 2.5 [CI: 0.7-8.4], = 0.11), although results were similar in both groups at later time points. At week 24, only one patient (4%) in RAI and three (12%) in MMI experienced worsening of GO. Fifty-nine adverse events were recorded among 36 patients, with no differences between groups, except for infections, which were more frequent in RAI (53.8% vs. 15.3% in MMI; OR = 6.41 [CI: 1.7-23.9], = 0.0056). RAI appears to be associated with an earlier response of GO to intravenous glucocorticoids. In the long term, a conservative approach also seems to be effective. RAI appears to be relatively safe when patients are concurrently treated with glucocorticoids. However, randomized clinical trials are necessary to confirm these findings.
格雷夫斯眼病（GO）患者的格雷夫斯甲亢（GH）治疗仍是一个有争议的话题。本研究旨在根据所选的甲状腺治疗方法，调查糖皮质激素治疗后GO的结果。这项回顾性队列研究纳入了49例连续的GH患者，且这些患者患有欧洲格雷夫斯眼病专家组指南所定义的中度至重度活动性GO。24例患者接受放射性碘（RAI）治疗，25例接受甲巯咪唑（MMI）治疗。所有患者均接受静脉注射甲泼尼龙。随访在第24周、48周和72周进行。主要终点是第24周时GO的总体结果。缓解定义为以下至少两个眼部特征的变化：临床活动评分降低≥1分；眼球突出减少≥2mm；睑裂减少≥2mm；眼动度增加≥8度。两组的随访时间均为72周（RAI组的四分位间距为66 - 72周，MMI组为48 - 72周）。RAI组第24周时GO总体结果的缓解者比例更高（54.1%对16%；优势比[OR]为6.2[置信区间(CI)：1.6 - 23.6]，P = 0.0075），但MMI组在第48周和72周时缓解者比例增加，两组之间无差异。就个体眼部特征而言，有趋势表明RAI组的反应更好。第24周时，RAI组GO特异性生活质量问卷的改善趋势更明显（缓解者50%对MMI组的28%；OR = 2.5[CI：0.7 - 8.4]，P = 0.11），尽管两组在后期时间点的结果相似。在第24周时，RAI组仅有1例患者（4%）和MMI组有3例患者（12%）的GO病情恶化。36例患者共记录了59起不良事件，除感染外两组之间无差异，RAI组感染更常见（53.8%对MMI组的15.3%；OR = 6.41[CI：1.7 - 23.9]，P = 0.0056）。RAI似乎与GO对静脉注射糖皮质激素的早期反应相关。从长期来看，保守治疗方法似乎也有效。当患者同时接受糖皮质激素治疗时，RAI似乎相对安全。然而，需要进行随机临床试验来证实这些发现。
