Bartalena L, Marcocci C, Bogazzi F, Manetti L, Tanda M L, Dell'Unto E, Bruno-Bossio G, Nardi M, Bartolomei M P, Lepri A, Rossi G, Martino E, Pinchera A
Istituto di Endocrinologia, University of Pisa, Ospedale Cisanello, Italy.
N Engl J Med. 1998 Jan 8;338(2):73-8. doi: 10.1056/NEJM199801083380201.
The chief clinical characteristics of Graves' disease are hyperthyroidism and ophthalmopathy. The relation between the two and the effect of treatment for hyperthyroidism on ophthalmopathy are unclear.
We studied 443 patients with Graves' hyperthyroidism and slight or no ophthalmopathy who were randomly assigned to receive radioiodine, radioiodine followed by a 3-month course of prednisone, or methimazole for 18 months. The patients were evaluated for changes in the function and appearance of the thyroid and progression of ophthalmopathy at intervals of 1 to 2 months for 12 months. Hypothyroidism and persistent nyperthyroiaism were promptly corrected.
Among the 150 patients treated with radioiodine, ophthalmopathy developed or worsened in 23 (15 percent) two to six months after treatment. The change was transient in 15 patients, but it persisted in 8 (5 percent), who subsequently required treatment for their eye disease. None of the 55 other patients in this group who had ophthalmopathy at base line had improvement in their eye disease. Among the 145 patients treated with radioiodine and prednisone, 50 (67 percent) of the 75 with ophthalmopathy at base line had improvement, and no patient had progression. The effects of radioiodine on thyroid function were similar in these two groups. Among the 148 patients treated with methimazole, 3 (2 percent) who had ophthalmopathy at base line improved, 4 (3 percent) had worsening of eye disease, and the remaining 141 had no change.
Radioiodine therapy for Graves' hyperthyroidism is followed by the appearance or worsening of ophthalmopathy more often than is therapy with methimazole. Worsening of ophthalmopathy after radioiodine therapy is often transient and can be prevented by the administration of prednisone.
格雷夫斯病的主要临床特征是甲状腺功能亢进和眼病。两者之间的关系以及甲状腺功能亢进治疗对眼病的影响尚不清楚。
我们研究了443例格雷夫斯甲状腺功能亢进且有轻微眼病或无眼病的患者，这些患者被随机分配接受放射性碘治疗、放射性碘治疗后接着使用3个月疗程的泼尼松治疗或接受甲巯咪唑治疗18个月。在12个月内，每隔1至2个月对患者的甲状腺功能和外观变化以及眼病进展进行评估。甲状腺功能减退和持续性甲状腺功能亢进均得到及时纠正。
在接受放射性碘治疗的150例患者中，23例（15%）在治疗后两至六个月出现或加重了眼病。其中15例患者的变化是短暂的，但8例（5%）持续存在，随后需要对其眼病进行治疗。该组中另外55例基线时有眼病的患者，其眼病均未改善。在接受放射性碘和泼尼松治疗的145例患者中，基线时有眼病的75例患者中有50例（67%）病情改善，无患者病情进展。这两组中放射性碘对甲状腺功能的影响相似。在接受甲巯咪唑治疗的148例患者中，基线时有眼病的3例（2%）病情改善，4例（3%）眼病加重，其余141例无变化。
与甲巯咪唑治疗相比，放射性碘治疗格雷夫斯甲状腺功能亢进后，眼病出现或加重的情况更常见。放射性碘治疗后眼病的加重通常是短暂的，可通过给予泼尼松来预防。
