Is radioiodine more likely than antithyroid drugs to worsen ophthalmopathy in patients with Graves disease?
Is radioiodine more likely than antithyroid drugs to worsen ophthalmopathy in patients with Graves disease?
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放射性碘是否比抗甲状腺药物更有可能加重格雷夫斯病患者的眼病？
DOI：
10.1038/ncpendmet0955
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发表时间：
2008
影响因子：
--
通讯作者：
Bahn,RebeccaS
中科院分区：
文献类型：
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作者：
Bahn,RebeccaS
这篇实践要点评论讨论了Acharyaet al.的系统综述的发现和局限性，该综述评估了放射性碘治疗Graves甲亢的效用。作者检查了10个随机对照试验，并集中在放射性碘和Graves眼病之间的潜在因果关系。他们得出结论，放射性碘治疗后Graves眼病的风险高于抗甲状腺药物治疗后的风险（相对风险[RR] 4.23）。放射性碘治疗后，严重Graves眼病的风险也增加（RR 4.35）。糖皮质激素预防在预防既存Graves眼病患者的疾病进展方面非常有效（RR 0.03）。在这里，我强调了在解释和概括这些结果时需要考虑的问题，例如各种试验中疾病分类和描述不一致所带来的限制。虽然这项系统性综述强调了放射性碘治疗后Graves眼病进展的小但真实的风险，但它不能提供对这种进展程度的深入了解，也不能确定哪些患者风险最高，因此可能从预防中获益最多。
This Practice Point commentary discusses the findings and limitations of a systematic review by Acharyaet al. that assessed the utility of radioiodine to treat Graves hyperthyroidism. The authors examined 10 randomized controlled trials, and focused on the potential causative relationship between radioiodine and Graves ophthalmopathy. They concluded that the risk of Graves ophthalmopathy following radioiodine therapy is higher than that after treatment with antithyroid drugs (relative risk [RR] 4.23). The risk of severe Graves ophthalmopathy was also found to be increased after treatment with radioiodine (RR 4.35). Glucocorticoid prophylaxis was highly effective in preventing disease progression in patients with pre-existing Graves ophthalmopathy (RR 0.03). Here, I highlight the issues to consider when interpreting and generalizing these results, such as the limitations imposed by the inconsistency of disease classification and description in the various trials. Although this systematic review highlighted the small but real risk of Graves ophthalmopathy progression following radioiodine therapy, it could not provide insight into the extent of this progression or identify which patients are at highest risk and so might benefit most from prophylaxis.