Clinical features of Graves' ophthalmopathy in an incidence cohort
Clinical features of Graves' ophthalmopathy in an incidence cohort
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DOI：
10.1016/s0002-9394(14)70276-4
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发表时间：
1996-03-01
影响因子：
4.2
通讯作者：
Gorman, CA
中科院分区：
文献类型：
--
作者：
Bartley, GB;Fatourechi, V;Gorman, CA
目的：确定格雷夫斯眼病发病队列的临床特征。 方法：我们回顾了居住在明尼苏达州奥姆斯特德县的 120 名患者的社区病历，这些患者在 1975 年至 1990 年间被诊断为格雷夫斯眼病。 结果：在 120 名格雷夫斯眼病患者中，108 名（90%）患者患有格雷夫斯眼病。 格雷夫斯甲状腺功能亢进症，1 例（1%）患有原发性甲状腺功能减退症，4 例（3%）患有桥本甲状腺炎，7 例（6%）甲状腺功能正常。在临床过程中的某个时刻，108 名患者出现眼睑回缩，而眼球突出的发生率大约为 62%（73 名患者）；限制性眼外肌病，43%（51 名患者）；视神经功能障碍，6%（七名患者）。只有六名（5%）患者出现眼睑退缩、眼球突出、视神经功能障碍、眼外肌受累和甲状腺功能亢进。在诊断眼病时，分别有 85 名和 52 名患者出现上眼睑退缩和眼睑滞后，最常见的眼部症状是疼痛（36 名患者，30%）。 20名患者在初次检查时发现复视，25名患者出现流泪，19名患者畏光，9名患者视力模糊。诊断时，只有不到 2% 的眼睛因视神经病变而出现视力下降。格雷夫斯眼病分别有 5 名患者 (4%) 和 1 名患者 (1%) 伴有甲状腺皮肤病和肢端肥大症。仅一名患者出现重症肌无力。结论：眼睑退缩是格雷夫斯眼病最常见的临床症状。一系列典型特征（甲状腺功能亢进、眼睑退缩、眼球突出、限制性眼外肌病和视神经功能障碍）相对较少发生。
PURPOSE: To determine the clinical characteristics of an incidence cohort of patients with Graves' ophthalmopathy.METHODS: We reviewed the community medical records of 120 patients residing in Olmsted Coun ty, Minnesota, in whom Graves' ophthalmopathy was diagnosed between 1975 and 1990.RESULTS: Among 120 patients with Graves' ophthalmopathy, 108 (90%) patients had Graves' hyperthyroidism, one (1%) had primary hypothyroidism, four (3%) had Hashimoto's thyroiditis, and seven (6%) were euthyroid. At some point in their clinical course, eyelid retraction was present in 108 patients, whereas the approximate frequency of exophthalmos was 62% (73 patients); restrictive extraocular myopathy, 43% (51 patients); and optic nerve dysfunction, 6% (seven patients). Only six (5%) patients had eyelid retraction, exophthalmos, optic nerve dysfunction, extraocular muscle involvement, and hyperthyroidism. At the time of diagnosis of ophthalmopathy, upper eyelid retraction and eyelid lag were documented in 85 and 52 patients, respectively, and the most frequent ocular symptom was pain (36 patients, 30%). Diplopia was noted at the initial examination by 20 patients, lacrimation was present in 25 patients, 19 patients had photophobia, and nine patients had blurred vision. Decreased vision from optic neuropathy was present in less than 2% of eyes at the time of diagnosis. Thyroid dermopathy and acropachy accompanied Graves' ophthalmopathy in five patients (4%) and one (1%) patient, respectively. Myasthenia gravis occurred in only one patient.CONCLUSIONS: Eyelid retraction is the most common clinical sign of Graves' ophthalmopathy. The complete constellation of typical features (hyperthyroidism, eyelid retraction, exophthalmos, restrictive extraocular myopathy, and optic nerve dysfunction) occurs relatively infrequently.