The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota.
The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota.
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发表时间：
1994
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通讯作者：
G. Bartley
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作者：
G. Bartley
在明尼苏达州奥姆斯特德县的GO事件病例中：GO影响女性的频率是男性的6倍（分别为86%和14%）。经年龄调整的发病率为女性每年每100 000人16例，男性每100 000人2.9例。发病率高峰呈双峰型，女性发生在40 - 44岁和60 - 64岁年龄组，男性发生在45 - 49岁和65 - 69岁年龄组。在GO患者中，约90%有Graves'甲状腺功能亢进症，1%有原发性甲状腺功能减退症，3%有桥本甲状腺炎，5%甲状腺功能正常。眼睑退缩是自身免疫性甲状腺疾病最常见的眼部特征，在90%以上的患者的临床过程中的某个时间点存在单侧或双侧眼睑退缩。约60%的患者单眼或双眼眼球突出，约40%的患者限制性眼外肌病明显，6%的自身免疫性甲状腺疾病患者单眼或双眼发生视神经功能障碍。只有5%的患者具有完整的典型表现：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GO时，约75%的患者记录了单侧或双侧上睑退缩。眼睑滞后也是一种常见的早期体征，在初次检查时50%的患者单侧或双侧出现。在诊断GO时，最常见的眼部症状是疼痛或不适，影响30%的患者。约17%的患者出现一定程度的复视，约15%至20%的患者出现流泪或畏光，7.5%的患者主诉视力模糊。在诊断为GO时，视神经病变导致的视力下降仅占不到2%。甲状腺皮肤病和肢端疼痛分别约有4%和1%的患者伴有GO。重症肌无力的发生率不到1%。上级边缘角膜结膜炎记录在不到4%的患者。诊断GO时的中位年龄为43岁（范围为8至88岁）。在甲亢患者中，61%在甲状腺毒症发病后1年内发生眼病。在初始和最终检查之间发生统计学显著变化的症状和体征包括流泪、疼痛或眼部不适、畏光、眼睑退缩、眼睑下垂、眼睑饱满、结膜充血、球结膜水肿和眼球突出。（400字处截断摘要）
Among incident cases of GO in Olmsted County, Minnesota: GO affected females six times more frequently than males (86% versus 14% of cases, respectively). The age-adjusted incidence rate was 16 cases per 100,000 population per year for females and 2.9 cases per 100,000 population for males. The peak incidence rates were bimodal, occurring in the age groups 40 to 44 years and 60 to 64 years in females and 45 to 49 years and 65 to 69 years in males. Among patients with GO, approximately 90% had Graves' hyperthyroidism, 1% had primary hypothyroidism, 3% had Hashimoto's thyroiditis, and 5% were euthyroid. Eyelid retraction was the most common ophthalmic feature of autoimmune thyroid disease, being present either unilaterally or bilaterally in more than 90% of patients at some point in their clinical course. Exophthalmos of one or both eyes affected approximately 60% of patients, restrictive extraocular myopathy was apparent in about 40% of patients, and optic nerve dysfunction occurred in either one or both eyes in 6% of patients with autoimmune thyroid disease. Only 5% of patients had the complete constellation of classic findings: eyelid retraction, exophthalmos, optic nerve dysfunction, extraocular muscle involvement, and hyperthyroidism. Upper eyelid retraction, either unilateral or bilateral, was documented in approximately 75% of patients at the time of diagnosis of GO. Lid lag also was a frequent early sign, being present either unilaterally or bilaterally in 50% of patients at the initial examination. At the time of diagnosis of GO, the most frequent ocular symptom was pain or discomfort, which affected 30% of patients. Some degree of diplopia was noted by approximately 17% of patients, lacrimation or photophobia was present in about 15% to 20% of patients, and 7.5% of patients complained of blurred vision. Decreased vision attributable to optic neuropathy was present in less than 2% of eyes at the time of diagnosis of GO. Thyroid dermopathy and acropachy accompanied GO in approximately 4% and 1% of patients, respectively. Myasthenia gravis occurred in less than 1% of patients. Superior limbic keratoconjunctivitis was documented in less than 4% of patients. The median age at the time of diagnosis of GO was 43 years (range, 8 to 88). Among patients with hyperthyroidism, 61% developed ophthalmopathy within 1 year of the onset of thyrotoxicosis. Symptoms and signs for which statistically significant changes occurred between the initial and final examinations included lacrimation, pain or ocular discomfort, photophobia, eyelid retraction, lid lag, eyelid fullness, conjunctival injection, chemosis, and exophthalmos.(ABSTRACT TRUNCATED AT 400 WORDS)