Long-term multidisciplinary follow-up of unilateral thyroid-associated orbitopathy
Long-term multidisciplinary follow-up of unilateral thyroid-associated orbitopathy
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DOI：
10.1016/j.ejim.2008.01.013
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发表时间：
2008-11-01
影响因子：
8
通讯作者：
Boschi, A.
中科院分区：
文献类型：
--
作者：
Daumerie, Ch.;Duprez, Th.;Boschi, A.
背景：甲状腺相关眼眶病(TAO)是一种以眼眶脂肪组织和眼外肌(EOM)同时受累为特征的自身免疫性疾病。虽然双侧或可能不对称的眼眶受累在放射学检查中很常见，但单眶受累的文献很少，并被归因于随后的双侧TAO的所有初始和/或暂时性。方法：从200名TAO患者中，我们回顾选择了14名最初临床上单侧TAO的患者。结果：性别比为0.8(4男，5女)，平均年龄44.6岁(18~63岁)。所有患者在进行初始磁共振成像(MRI)时甲状腺功能正常。1例患者因亚临床甲状腺功能减退症而接受左旋甲状腺素治疗。Graves病8例(6例)，病程1~4年，用抗甲状腺药物治疗。两名患者接受了甲状腺切除术。所有患者均未接受过放射性碘治疗。6例患者停用抗甲状腺药物后甲状腺功能恢复正常，2例转为甲状腺功能减退。7例患者为活动期，2例为重度TAO。在最初的MRI上，9名患者中有4名显示双侧TAO。所有患者的临床状况最终都有所改善或恢复正常。2例患者9年后行MRI检查，发现EOMS部分缩小，受累肌肉脂肪消退。结论：单侧TAO与双侧TAO并无不同，程度相同。在最初的检查中，MRI显示45%(4/9)为双侧征象，轻度受累，或有2块眼外肌受累。即使在很长一段时间内，受影响肌肉的放射状态也不会恢复正常。(C)2008年欧洲内科医学联合会。爱思唯尔出版，版权所有。
Background: Thyroid-Associated Orbitopathy (TAO) is ail autoimmune disease characterized by orbital inflammation involving both adipose tissue and extra-ocular muscles (EOM). Whereas bilateral and possibly asymmetric orbital involvement is commonly found at radiological workup, mono-orbital involvement is poorly documented, and ascribed to ail initial and/or transient stage of subsequent bilateral TAO.Methods: From a cohort of two hundred TAO patients, we selected retrospectively fourteen patients with initial clinical unilateral TAO. Five of them were excluded because of clinical bilateralization.Results: The sex ratio was 0.8 (4M, 5F) and mean age 44.6 years (range: 18-63). All patients were euthyroid when the initial magnetic resonance imaging (MRI) was performed. One patient was treated with Levothyroxine, because of subclinical hypothyroidism. Eight patients (six snickers) Suffered from Graves' disease, of 1-4 years duration, for which they were treated with antithyroid drugs. A thyroidectomy was performed in two patients. None of the patients ever received radioiodine. Six patients remained euthyroid after stopping of the antithyroid regimen, and two became hypothyroid. Seven patients had active, and two severe TAO. Four of nine patients exhibited bilateralization of TAO on initial MRI. Clinical status ultimately improved or normalized in all. In two patients, MRI performed after 9 years demonstrated partial shrinkage of previously enlarged EOMs, together with fatty involution of involved muscles.Conclusions: Unilateral TAO is not different and just as severe as bilateral TAO. At initial work-Up MRI shows signs of bi-laterality in 45% (4/9), with mild involvement off or 2 extra-ocular muscles. The radiological status of affected muscles does not normalize, even in the very long term. (C) 2008 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.