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초록
Graves’ ophthalmopathy (GO) is an autoimmune disease associated with orbital inflammation and fibrosis which can result in lid retraction, soft tissue swelling, and proptosis. Treatment should rely on a thorough assessment of the activity and severity of GO. Control of risk factors for GO progression and topical treatments for dry eye are recommended for all patients. In mild GO, a careful observation is usually sufficient. In moderate-to-severe and active GO, high-dose intravenous glucocorticoids can be considered an initial treatment. The most common schedule for intravenous glucocorticoids is a cumulative dose of 4.5 g of methylprednisolone, divided into 12 weekly infusions (6 weekly infusions of 0.5 g, followed by 6 weekly infusions of 0.25 g). Orbital radiation has been shown to be an effective secondary treatment in patients with active GO unresponsive to intravenous glucocorticoids. Rehabilitative surgery is needed in patients with GO when the disease is associated with a significant impact on quality of life or visual function after the disease has been inactive for at least 6 months.
REFERENCES
1). Bartley GB. The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota. Trans Am Ophthalmol Soc. 1994; 92:477–588.
2). Smith TJ, Bahn RS, Gorman CA, Cheavens M. Stimulation of glycosaminoglycan accumulation by interferon gamma in cultured human retroocular fibroblasts. J Clin Endocrinol Metab. 1991; 72(5):1169–71.
3). Smith TJ, Hoa N. Immunoglobulins from patients with Graves' disease induce hyaluronan synthesis in their orbital fibroblasts through the self-antigen, insulin-like growth factor-I receptor. J Clin Endocrinol Metab. 2004; 89(10):5076–80.
4). Wiersinga WM, Bartalena L. Epidemiology and prevention of Graves' ophthalmopathy. Thyroid. 2002; 12(10):855–60.
5). Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves' ophthalmopathy. Clin Endocrinol (Oxf). 1997; 47(1):9–14.
6). Bartalena L, Baldeschi L, Dickinson A, Eckstein A, Kendall-Taylor P, Marcocci C, et al. Consensus statement of the European Group on Graves' orbitopathy (EUGOGO) on management of GO. Eur J Endocrinol. 2008; 158(3):273–85.
7). Bartalena L, Baldeschi L, Dickinson AJ, Eckstein A, Kendall-Taylor P, Marcocci C, et al. Consensus statement of the European group on Graves' orbitopathy (EUGOGO) on management of Graves' orbitopathy. Thyroid. 2008; 18(3):333–46.
8). Karlsson F, Dahlberg P, Jansson R, Westermark K, Enoksson P. Importance of TSH receptor activation in the development of severe endocrine ophthalmopathy. Acta endocrinologica. Supplementum. 1989; 121(2):132–41.
9). Prummel MF, Wiersinga WM, Mourits MP, Koornneef L, Berghout A, Van der Gaag R. Amelioration of eye changes of Graves' ophthalmopathy by achieving euthyroidism. Acta Endocrinologica. 1989; 121(Supple 2):185–189.
10). Bartalena L, Marcocci C, Bogazzi F, Manetti L, Tanda ML, Dell'Unto E, et al. Relation between therapy for hyperthyroidism and the course of Graves' ophthalmopathy. N Engl J Med. 1998; 338(2):73–8.
11). Li HX, Xiang N, Hu WK, Jiao XL. Relation between therapy options for Graves' disease and the course of Graves' ophthalmopathy: a systematic review and metaanalysis. J Endocrinol Invest. 2016; 39(11):1225–33.
12). Acharya SH, Avenell A, Philip S, Burr J, Bevan JS, Abraham P. Radioiodine therapy (RAI) for Graves' disease (GD) and the effect on ophthalmopathy: a systematic review. Clin Endocrinol (Oxf). 2008; 69(6):943–50.
13). Lai A, Sassi L, Compri E, Marino F, Sivelli P, Piantanida E, et al. Lower dose prednisone prevents radioiodine-associated exacerbation of initially mild or absent graves' orbitopathy: a retrospective cohort study. J Clin Endocrinol Metab. 2010; 95(3):1333–7.
14). Shiber S, Stiebel-Kalish H, Shimon I, Grossman A, Robenshtok E. Glucocorticoid regimens for prevention of Graves' ophthalmopathy progression following radioiodine treatment: systematic review and metaanalysis. Thyroid. 2014; 24(10):1515–23.
15). Prummel MF, Wiersinga WM. Smoking and risk of Graves' disease. JAMA. 1993; 269(4):479–82.
16). Eckstein A, Quadbeck B, Mueller G, Rettenmeier AW, Hoermann R, Mann K, et al. Impact of smoking on the response to treatment of thyroid associated ophthalmopathy. Br J Ophthalmol. 2003; 87(6):773–6.
17). Traisk F, Tallstedt L, Abraham-Nordling M, Andersson T, Berg G, Calissendorff J, et al. Thyroid-associated ophthalmopathy after treatment for Graves' hyperthyroidism with antithyroid drugs or iodine-131. J Clin Endocrinol Metab. 2009; 94(10):3700–7.
18). Tanda ML, Piantanida E, Liparulo L, Veronesi G, Lai A, Sassi L, et al. Prevalence and natural history of Graves' orbitopathy in a large series of patients with newly diagnosed graves' hyperthyroidism seen at a single center. J Clin Endocrinol Metab. 2013; 98(4):1443–9.
19). Gurdal C, Sarac O, Genc I, Kirimlioglu H, Takmaz T, Can I. Ocular surface and dry eye in Graves' disease. Curr Eye Res. 2011; 36(1):8–13.
20). Kocabeyoglu S, Mocan MC, Cevik Y, Irkec M. Ocular Surface Alterations and In Vivo Confocal Microscopic Features of Corneas in Patients With Newly Diagnosed Graves' Disease. Cornea. 2015; 34(7):745–9.
21). Rayman MP. Selenium and human health. Lancet. 2012; 379(9822):1256–68.
22). Marcocci C, Kahaly GJ, Krassas GE, Bartalena L, Prummel M, Stahl M, et al. Selenium and the course of mild Graves' orbitopathy. N Engl J Med. 2011; 364(20):1920–31.
23). Jang JY, Cho YY, Kim TH, Kim SW, Chung JH. Selenium concentration in Korean patients with thyroid disease: a preliminary report. Int J Thyroidol. 2016; 9(2):152–8.
24). Zang S, Kahaly GJ. Steroids and the immune response in Graves orbitopathy. Immunol Endocr Metab Agents Med. 2011; 11(2):90–8.
25). Stiebel-Kalish H, Robenshtok E, Hasanreisoglu M, Ezrachi D, Shimon I, Leibovici L. Treatment modalities for Graves' ophthalmopathy: systematic review and metaanalysis. J Clin Endocrinol Metab. 2009; 94(8):2708–16.
26). Zhu W, Ye L, Shen L, Jiao Q, Huang F, Han R, et al. A prospective, randomized trial of intravenous glucocorticoids therapy with different protocols for patients with graves' ophthalmopathy. J Clin Endocrinol Metab. 2014; 99(6):1999–2007.
27). Bartalena L, Krassas GE, Wiersinga W, Marcocci C, Salvi M, Daumerie C, et al. Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves' orbitopathy. J Clin Endocrinol Metab. 2012; 97(12):4454–63.
28). Kahaly GJ, Pitz S, Hommel G, Dittmar M. Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves' orbitopathy. J Clin Endocrinol Metab. 2005; 90(9):5234–40.
29). Zang S, Ponto KA, Pitz S, Kahaly GJ. Dose of intravenous steroids and therapy outcome in Graves' orbitopathy. J Endocrinol Invest. 2011; 34(11):876–80.
30). Marcocci C, Watt T, Altea MA, Rasmussen AK, Feldt- Rasmussen U, Orgiazzi J, et al. Fatal and non-fatal adverse events of glucocorticoid therapy for Graves' orbitopathy: a questionnaire survey among members of the European Thyroid Association. Eur J Endocrinol. 2012; 166(2):247–53.
31). Riedl M, Kolbe E, Kampmann E, Kramer I, Kahaly GJ. Prospectively recorded and MedDRA-coded safety data of intravenous methylprednisolone therapy in Graves' orbitopathy. J Endocrinol Invest. 2015; 38(2):177–82.
32). Sandler HM, Rubenstein JH, Fowble BL, Sergott RC, Savino PJ, Bosley TM. Results of radiotherapy for thyroid ophthalmopathy. Int J Radiat Oncol Biol Phys. 1989; 17(4):823–7.
33). Kazim M, Trokel S, Moore S. Treatment of acute Graves orbitopathy. Ophthalmology. 1991; 98(9):1443–8.
34). Bartalena L, Pinchera A, Marcocci C. Management of Graves' ophthalmopathy: reality and perspectives. Endocr Rev. 2000; 21(2):168–99.
35). Marcocci C, Bartalena L, Rocchi R, Marino M, Menconi F, Morabito E, et al. Long-term safety of orbital radiotherapy for Graves' ophthalmopathy. J Clin Endocrinol Metab. 2003; 88(8):3561–6.
36). Salvi M, Vannucchi G, Curro N, Campi I, Covelli D, Dazzi D, et al. Efficacy of B-cell targeted therapy with rituximab in patients with active moderate to severe Graves' orbitopathy: a randomized controlled study. J Clin Endocrinol Metab. 2015; 100(2):422–31.
37). Stan MN, Garrity JA, Carranza Leon BG, Prabin T, Bradley EA, Bahn RS. Randomized controlled trial of rituximab in patients with Graves' orbitopathy. J Clin Endocrinol Metab. 2015; 100(2):432–41.
38). Shen WC, Lee CH, Loh EW, Hsieh AT, Chen L, Tam KW. Efficacy and Safety of Rituximab for the Treatment of Graves' Orbitopathy: A Meta-analysis of Randomized Controlled Trials. Pharmacotherapy. 2018; 38(5):503–10.
39). Smith TJ, Kahaly GJ, Ezra DG, Fleming JC, Dailey RA, Tang RA, et al. Teprotumumab for Thyroid-Associated Ophthalmopathy. N Engl J Med. 2017; 376(18):1748–61.
40). Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, et al. The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy. Eur Thyroid J. 2016; 5(1):9–26.
41). Curro N, Covelli D, Vannucchi G, Campi I, Pirola G, Simonetta S, et al. Therapeutic outcomes of high-dose intravenous steroids in the treatment of dysthyroid optic neuropathy. Thyroid. 2014; 24(5):897–905.
42). Wiersinga WM, Kahaly GJ. Graves' orbitopathy: a multidisci-plinary approach-questions and answers. 3rd revised and expanded edition. Basel; New York: Karger. 2017.
43). Huh J, Lee JK. Change in quality of life after orbital decompression surgery in patients with dysthyroid ophthalmopathy. J Korean Ophthalmol Soc. 2016; 57(10):1514–20.
44). Choi SU, Kim KW, Lee JK. Surgical outcomes of balanced deep lateral and medial orbital wall decompression in Korean population: clinical and computed tomography-based analysis. Korean J Ophthalmol. 2016; 30(2):85–91.
45). Lim KS, Lee JK. Evaluation of stereotactic navigation during orbital decompression in thyroid-associated orbitopathy patients. J Korean Ophthalmol Soc. 2014; 55(3):337–42.
46). Eckstein A, Esser J. Surgical management of extraocular muscle dysfunction in patients with GO. Bahn RS, editor. Graves' disease: a comprehensive guide for clinicians. New York: Springer;2015. p. 287–99.
47). Chee E, Chee SP. Subconjunctival injection of triamcinolone in the treatment of lid retraction of patients with thyroid eye disease: a case series. Eye (Lond). 2008; 22(2):311–5.
Fig. 1.
Management of Graves’ ophthalmopathy based on recommendation of European Group on Graves’ Orbitopathy (EUGOGO).
Table 1.
Assessment of Graves ophthalmopathy activity and severity
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