ketendoКлиническая и экспериментальная тиреоидологияClinical and experimental thyroidology1995-54722310-3787Endocrinology Research Centre10.14341/ket20106316-23ketendo-4278Research ArticleСтатьиArticlesЛечение инфильтративной офтальмопатииTreatment of Graves' ophthalmopathyDalmatovaA B-GrinevaE N-20101509201063ТОМ 6, №3 (2010)1623Copyright © Dalmatova A.B., Grineva E.N., 20102010Dalmatova A.B., Grineva E.N.Dalmatova A.B., Grineva E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.cet-endojournals.ru/jour/article/view/4278

Инфильтративная офтальмопатия – наиболее частое экстратиреоидное проявление аутоиммунных заболеваний щитовидной железы. В 3–5% случаев она имеет тяжелое течение и требует назначения специальной терапии. Существование большого количества способов лечения офтальмопатии и появление новых свидетельствуют об отсутствии достаточно эффективного метода ее лечения. В настоящем обзоре предпринята попытка систематизировать имеющиеся данные. Также в обзоре представлены рекомендации консенсуса European Group on Graves' Orbitopathy (EUGOGO) по лечению офтальмопатии.

Graves' ophthalmopathy is one of most frequent extrathyroid manifestation of autoimmune thyroid diseases. In 3–5% cases it has severe progress and requires specific therapy. There are many methods of treatment and it's getting more and more, but that demonstrate no sufficient effectiveness. In this review was made an essay to systematize current data. Also guidelines of consensus EUGOGO for treatment of ophtalmopathy is represented here.

инфильтративная офтальмопатияэндокринная офтальмопатиялечениеinfiltrative ophthalmoparthyendocrine ophthalmoparthytrearmentReferencesБровкина А.Ф. Эндокринная офтальмопатия. М.: Гоэтар Медиа, 2004.Бровкина А.Ф. Эндокринная офтальмопатия. М.: Гоэтар Медиа, 2004.Залевская А.Г., Благосклонная Я.В. Случай тяжелой офтальмопатии при эутиреозе // Пробл. эндокринол. 1985. №6. С. 40–41.Залевская А.Г., Благосклонная Я.В. Случай тяжелой офтальмопатии при эутиреозе // Пробл. эндокринол. 1985. №6. С. 40–41.Balazs C., Kiss E., Vamos A., Molnar I, Farid N.R. 1998 Beneficial effect of pentoxyfilline on thyroid-associated ophthalmopathy // J. Clin. Endocrinol. Metab. V. 82. P. 1999–2002.Balazs C., Kiss E., Vamos A., Molnar I, Farid N.R. 1998 Beneficial effect of pentoxyfilline on thyroid-associated ophthalmopathy // J. Clin. Endocrinol. Metab. V. 82. P. 1999–2002.Bartalena L., Marcocci C., Pinchera A. Cytokine antagonists: new ideas for the management of Graves` ophthalmopathy // J. Clin. Endocrinol. Metab. 1996. V. 81. P. 446–448.Bartalena L., Marcocci C., Pinchera A. Cytokine antagonists: new ideas for the management of Graves` ophthalmopathy // J. Clin. Endocrinol. Metab. 1996. V. 81. P. 446–448.Bartalena L., Marcocci C., Tanda M.L. et al. Relation between therapy for hyperthyroidism and the course of Graves` ophtalmopathy // N. Engl. J. Med. 1998. V. 338. P. 73–78.Bartalena L., Marcocci C., Tanda M.L. et al. Relation between therapy for hyperthyroidism and the course of Graves` ophtalmopathy // N. Engl. J. Med. 1998. V. 338. P. 73–78.Bartalena L., Marcocci C., Manetti L., Tanda M.L. et al. Orbital radiotherapy for Graves` ophtalmopathy // Thyroid. 1998. V. 8. P. 439–441.Bartalena L., Marcocci C., Manetti L., Tanda M.L. et al. Orbital radiotherapy for Graves` ophtalmopathy // Thyroid. 1998. V. 8. P. 439–441.Bartalena L., Pinchera A., Marcocci C. Management of Graves` ophtalmopathy: reality and perspectives // Endocr. Rev. 2000. V. 21. P. 168–199.Bartalena L., Pinchera A., Marcocci C. Management of Graves` ophtalmopathy: reality and perspectives // Endocr. Rev. 2000. V. 21. P. 168–199.Bartalena L., Marcocci C., Pinchera A. Graves` ophtalmopathy: a preventable disease. 2002. V. 146. P. 457–461.Bartalena L., Marcocci C., Pinchera A. Graves` ophtalmopathy: a preventable disease. 2002. V. 146. P. 457–461.Bartalena L. Glucocorticoids for Graves` ophtalmopathy: how and when // J. Clin. Endocrinol. Metab. 2005. V. 90. P. 5497–5499.Bartalena L. Glucocorticoids for Graves` ophtalmopathy: how and when // J. Clin. Endocrinol. Metab. 2005. V. 90. P. 5497–5499.Bartalena L., Baldeschi L., Dickinson A.J. et al. Consensus statement of the European Group on Graves` orbitopathy (EUGOGO) on management of Graves` orbitopathy // Thyroid. 2008. V. 18. V. 3. P. 333–345.Bartalena L., Baldeschi L., Dickinson A.J. et al. Consensus statement of the European Group on Graves` orbitopathy (EUGOGO) on management of Graves` orbitopathy // Thyroid. 2008. V. 18. V. 3. P. 333–345.Bartley G.B., Fatourechi V. et al. Long-term followup of Graves' ophthalmopathy in an incidence cohort // Ophthalmology. 1996. V. 103. P. 958–962.Bartley G.B., Fatourechi V. et al. Long-term followup of Graves' ophthalmopathy in an incidence cohort // Ophthalmology. 1996. V. 103. P. 958–962.Chang T.C., Kao S. C.S., Huang K.M. Octreotide and Graves` ophtalmopathy and pretibal myxoedema // Br. Med. 1992. V. 304. P. 580.Chang T.C., Kao S. C.S., Huang K.M. Octreotide and Graves` ophtalmopathy and pretibal myxoedema // Br. Med. 1992. V. 304. P. 580.Dandona P. Methylprednisolone and Graves` ophtalmopathy // Br. Med. J. 1989. V. 298. P. 830.Dandona P. Methylprednisolone and Graves` ophtalmopathy // Br. Med. J. 1989. V. 298. P. 830.Guy J., Fagien S., Donovan J. P., Rubin M. L. Methylprednisolone pulse therapy in severe dysthyroid optic neuropathy // Ophthalmology. 1989. V. 96. P. 1048–1052.Guy J., Fagien S., Donovan J. P., Rubin M. L. Methylprednisolone pulse therapy in severe dysthyroid optic neuropathy // Ophthalmology. 1989. V. 96. P. 1048–1052.Hiromatsu Y., Kojima K., Ishisaka N. et al. Role of magnetic resonance imaging in thyroid-associated ophtalmopathy: its predictive value for therapeutic outcime of immunosuppressive therapy // Thyroid. 1992. V. 2. P. 299–305.Hiromatsu Y., Kojima K., Ishisaka N. et al. Role of magnetic resonance imaging in thyroid-associated ophtalmopathy: its predictive value for therapeutic outcime of immunosuppressive therapy // Thyroid. 1992. V. 2. P. 299–305.Hiromatsu Y., Tanaka K., Sato M. et al. Intravenous methylprednisolone pulse therapy of Graves` ophthalmopathy // Endocr. J. 1993. V. 40. P. 63–72.Hiromatsu Y., Tanaka K., Sato M. et al. Intravenous methylprednisolone pulse therapy of Graves` ophthalmopathy // Endocr. J. 1993. V. 40. P. 63–72.Jarhult J., Rudberg C., Larsson E., Selvander H. et al. Graves` disease with moderate-severe endocrine ophthalmopathy – long term results of a prospective, randomozed study of total or subtotal thyroid resection // Thyroid. 2005. V. 15. P. 1157–1164.Jarhult J., Rudberg C., Larsson E., Selvander H. et al. Graves` disease with moderate-severe endocrine ophthalmopathy – long term results of a prospective, randomozed study of total or subtotal thyroid resection // Thyroid. 2005. V. 15. P. 1157–1164.Kauppinen Makelin R., Karmi A., Leinonen E. et al. High dose intravenous methylprednisolone pulse therapy versus oral prednisone for thyroidassociated ophthalmopathy // Acta Ophtalmol. Scand. 2002. V. 80. P. 316–321.Kauppinen Makelin R., Karmi A., Leinonen E. et al. High dose intravenous methylprednisolone pulse therapy versus oral prednisone for thyroidassociated ophthalmopathy // Acta Ophtalmol. Scand. 2002. V. 80. P. 316–321.Kahaly G., Schrezenmeir J., Krauze U. et al. Ciclosporin and prednisone vs. Prednisone in treatment of Graves` ophthalmopathy: a controlled, randomized and prospective study. // Eur. J. Clin. Invest. 1986. V. 16. P. 415–422.Kahaly G., Schrezenmeir J., Krauze U. et al. Ciclosporin and prednisone vs. Prednisone in treatment of Graves` ophthalmopathy: a controlled, randomized and prospective study. // Eur. J. Clin. Invest. 1986. V. 16. P. 415–422.Kahaly G., Diaz M., Just M. et al. Role of ostreoscan and correlation with MR imaging in Graves` ophtalmopathy // Thyroid. 1995. V. 5. P. 107–111.Kahaly G., Diaz M., Just M. et al. Role of ostreoscan and correlation with MR imaging in Graves` ophtalmopathy // Thyroid. 1995. V. 5. P. 107–111.Kahaly G.J., Rosler H. P., Pitz S., Hommel G. Low-versus high-dose radiotherapy for Graves` ophtalmopathy: a randomized, single dlind trial // J. Clin Endocrinol. Metab. 2000. V. 85. P. 102–108.Kahaly G.J., Rosler H. P., Pitz S., Hommel G. Low-versus high-dose radiotherapy for Graves` ophtalmopathy: a randomized, single dlind trial // J. Clin Endocrinol. Metab. 2000. V. 85. P. 102–108.Kahaly G. J., Pitz S., Hommel G., Dittmar M. Randomized, singleblind trial of intravenous versus oral steroid monotherapy in Graves` ophtalmopathy // J. Endocrinol. Metab. 2005. V. 90. P. 5234–5240.Kahaly G. J., Pitz S., Hommel G., Dittmar M. Randomized, singleblind trial of intravenous versus oral steroid monotherapy in Graves` ophtalmopathy // J. Endocrinol. Metab. 2005. V. 90. P. 5234–5240.Kendall Taylor P., Crombie A.L., Stephenson A.M. et al. Intravenous methylprednisolone in the treatment of Graves` ophtalmopathy // Br. Med. J. 1988. V. 297. P. 1574–1578.Kendall Taylor P., Crombie A.L., Stephenson A.M. et al. Intravenous methylprednisolone in the treatment of Graves` ophtalmopathy // Br. Med. J. 1988. V. 297. P. 1574–1578.Krassas G. E., Dumas A., Pontikides N., Kaltsas T. Somatostatin receptor scintigraphy andoctreotide treatment in patients with thyroid eye disease // Clin. Endocrinol. 1995. V. 42. P. 571–580.Krassas G. E., Dumas A., Pontikides N., Kaltsas T. Somatostatin receptor scintigraphy andoctreotide treatment in patients with thyroid eye disease // Clin. Endocrinol. 1995. V. 42. P. 571–580.Krassas G.E., Kaltsas T., Dumas A., Pontikides N., Tolis G. Lanreotide in the treatment of patients with thyroid eye disease // Eur. J. Endocrinol. 1997. V. 136. P. 416–422.Krassas G.E., Kaltsas T., Dumas A., Pontikides N., Tolis G. Lanreotide in the treatment of patients with thyroid eye disease // Eur. J. Endocrinol. 1997. V. 136. P. 416–422.Krassas G. E., Wiersinga W.M. Modern conceptions of diagnostic and management of TAO // Thyroid Int. 2005. V. 4. P. 1–20.Krassas G. E., Wiersinga W.M. Modern conceptions of diagnostic and management of TAO // Thyroid Int. 2005. V. 4. P. 1–20.Le Moli R., Baldeschi L., Seed P. et al. Determinants of liver damage associated with intravenous methylprednisolone pulse therapy in Graves` ophtalmopathy // Thyroid. 2007. V. 12. P. 357–362.Le Moli R., Baldeschi L., Seed P. et al. Determinants of liver damage associated with intravenous methylprednisolone pulse therapy in Graves` ophtalmopathy // Thyroid. 2007. V. 12. P. 357–362.Macchia P. E., Bagattini M., Lupoli G. et al. High-dose intravenous corticosteroid therapy for Graves` ophtalmopathy // J. Endocrinol. Invest. 2001. V. 24. P. 152–158.Macchia P. E., Bagattini M., Lupoli G. et al. High-dose intravenous corticosteroid therapy for Graves` ophtalmopathy // J. Endocrinol. Invest. 2001. V. 24. P. 152–158.Marcocci C., Bartalena L. et al. Orbital cobalt irradiation combined with retrobulbar or systemic corticosteroids for Graves'ophthalmopathy: a comparative study // Clin. Endocrinol. 1987. V. 27. P. 33–42.Marcocci C., Bartalena L. et al. Orbital cobalt irradiation combined with retrobulbar or systemic corticosteroids for Graves'ophthalmopathy: a comparative study // Clin. Endocrinol. 1987. V. 27. P. 33–42.Marino M., Morabito E., Brunetto M.R. et al. Acute and severe liver damage associated with intravenous glucocorticoid pulse therapy in patients with Graves` ophtalmopathy // Thyroid. 2000. V. 14. P. 403–406.Marino M., Morabito E., Brunetto M.R. et al. Acute and severe liver damage associated with intravenous glucocorticoid pulse therapy in patients with Graves` ophtalmopathy // Thyroid. 2000. V. 14. P. 403–406.Marquez S.D., Lum B.L., McDougall I.R. et al. Long-term results of irradiation for patients with Graves` ophtalmopathy // Int. J. Rad. Oncol. Biol. Phys. 2001. V. 51. P. 766–774.Marquez S.D., Lum B.L., McDougall I.R. et al. Long-term results of irradiation for patients with Graves` ophtalmopathy // Int. J. Rad. Oncol. Biol. Phys. 2001. V. 51. P. 766–774.Menconi F., Marino M., Pinchera A., Rocchi L. et al. Effects of total thyroid ablation versus near-total thyroidectomy alone on mild to moderate Graves` ophtalmopathy treated with intravenous glucocorticoids // J. Clin. Endocrinol. Metab. 2007. V. 92. P. 1653–1658.Menconi F., Marino M., Pinchera A., Rocchi L. et al. Effects of total thyroid ablation versus near-total thyroidectomy alone on mild to moderate Graves` ophtalmopathy treated with intravenous glucocorticoids // J. Clin. Endocrinol. Metab. 2007. V. 92. P. 1653–1658.Mourits M. P., Prummel M. F., Wiersina W. M., Koorneef L. Clinical activity score as a guide in the management of patients with Graves` ophtalmopathy // Clin. Endocrinol. 1997. V. 47. P. 9–14.Mourits M. P., Prummel M. F., Wiersina W. M., Koorneef L. Clinical activity score as a guide in the management of patients with Graves` ophtalmopathy // Clin. Endocrinol. 1997. V. 47. P. 9–14.Nabipour I., Burger A., Moharreri M. Avicenna, the First to Discribe Thyroid-Related Orbitopathy // Thyroid. 2009. V. 19. N1. P. 7–8.Nabipour I., Burger A., Moharreri M. Avicenna, the First to Discribe Thyroid-Related Orbitopathy // Thyroid. 2009. V. 19. N1. P. 7–8.Nagayama Y., Izumi M., Kiriyama T. et al. Treatment of Graves` ophtalmopathy with high-dose intravennous methylprednisolone pulse therapy // Acta. Endocrinol. 1987. V. 116. P. 513–518.Nagayama Y., Izumi M., Kiriyama T. et al. Treatment of Graves` ophtalmopathy with high-dose intravennous methylprednisolone pulse therapy // Acta. Endocrinol. 1987. V. 116. P. 513–518.Perros P., David R. et al. Azathioprine in the treatment of thyroidassociated ophthalmopathy // Acta. Endocrinol. 1990. V. 122 (1). P. 8–12.Perros P., David R. et al. Azathioprine in the treatment of thyroidassociated ophthalmopathy // Acta. Endocrinol. 1990. V. 122 (1). P. 8–12.Pinchera A., Bartalena L., Chiovato L., Marcocci C. Radiotherapy of Graves`ophthalmopathy. New York: Raven Press, 1984. P. 301–316.Pinchera A., Bartalena L., Chiovato L., Marcocci C. Radiotherapy of Graves`ophthalmopathy. New York: Raven Press, 1984. P. 301–316.Prummel M.F., Wiersinga W.M. Immunomodulatory treatment of Graves` ophtalmopathy // Thyroid. 1998. V. 8. P. 543–546.Prummel M.F., Wiersinga W.M. Immunomodulatory treatment of Graves` ophtalmopathy // Thyroid. 1998. V. 8. P. 543–546.Prummel M.F., Wiersinga W.M. Smoking and risk of Graves` disease // JAMA. 1993. V. 269. P. 479–482.Prummel M.F., Wiersinga W.M. Smoking and risk of Graves` disease // JAMA. 1993. V. 269. P. 479–482.Prummel M.F., Mourits M.P., Berghout A., Krenning E.P. et al. Prednisone and cyclosporine in the treatment of severe Graves` ophtalmopathy // N. Engl. J. Med. 1989. V. 321. P. 1353–1359.Prummel M.F., Mourits M.P., Berghout A., Krenning E.P. et al. Prednisone and cyclosporine in the treatment of severe Graves` ophtalmopathy // N. Engl. J. Med. 1989. V. 321. P. 1353–1359.Prummel M.F., Wiersinga W.M., Mourits M.P. et al. Amelioration of eye changes of Graves` ophtalmopathy by achieving euthyroidism // Acta. Endocrinol. 1989. V. 121 (Suppl. 2). P. 185–189.Prummel M.F., Wiersinga W.M., Mourits M.P. et al. Amelioration of eye changes of Graves` ophtalmopathy by achieving euthyroidism // Acta. Endocrinol. 1989. V. 121 (Suppl. 2). P. 185–189.Prummel M.F., Wiersinga W.M., Mourits M.P. et al. Effect of abnormal thyroid function on the severity of Graves` ophtalmopathy // Arch. Intern. Med. 1990. V. 150. P. 1098–1101.Prummel M.F., Wiersinga W.M., Mourits M.P. et al. Effect of abnormal thyroid function on the severity of Graves` ophtalmopathy // Arch. Intern. Med. 1990. V. 150. P. 1098–1101.Prummel M.F., Mourits M.P., Blank L. et al. Randomised doubleblind trial of prednisone versus radiotherapy in Graves` ophtalmopathy // Lancet. 1993. V. 342. P. 949–954.Prummel M.F., Mourits M.P., Blank L. et al. Randomised doubleblind trial of prednisone versus radiotherapy in Graves` ophtalmopathy // Lancet. 1993. V. 342. P. 949–954.Raza A. Anti-TNF theraputies in rheumatoid arthritis, Crohn`s disease, sepsis and myelodysplatic syndromes // Microsc. Res. Tech. 2000. V. 50. P. 229–235.Raza A. Anti-TNF theraputies in rheumatoid arthritis, Crohn`s disease, sepsis and myelodysplatic syndromes // Microsc. Res. Tech. 2000. V. 50. P. 229–235.Salvi M., Vannucchi G. et al. Rituximab in the treatment of thyroid eye disease: science fiction? // Orbit. 2009. V. 28. P. 251-255.Salvi M., Vannucchi G. et al. Rituximab in the treatment of thyroid eye disease: science fiction? // Orbit. 2009. V. 28. P. 251-255.Stamal F. G., Maciel R.M. et al. Colchicine in the treatment oft he inflammatory phase of Graves' ophthalmopathy: a prospective and randomized trial with prednisolone // Acta. Bras. Oftalmol. 2006. V. 69. P. 811–816.Stamal F. G., Maciel R.M. et al. Colchicine in the treatment oft he inflammatory phase of Graves' ophthalmopathy: a prospective and randomized trial with prednisolone // Acta. Bras. Oftalmol. 2006. V. 69. P. 811–816.Wakelkamp I.M., Tan. H., Saeed P. et al. Orbital irradiation for Graves` ophtalmopathy: is it safe? A long-term follow-up study // Ophthalmology. 2004. V. 111. P. 1557–1562.Wakelkamp I.M., Tan. H., Saeed P. et al. Orbital irradiation for Graves` ophtalmopathy: is it safe? A long-term follow-up study // Ophthalmology. 2004. V. 111. P. 1557–1562.Wall J.R., Strakosch C.R. et al. Thyroid binding antibodies and other immunological abnormalities in patien with Graves's ophthalmopathy: effect of cyclophosphamide // Clin. Endocrinol. 1979. V. 10 (1). P. 79–91.Wall J.R., Strakosch C.R. et al. Thyroid binding antibodies and other immunological abnormalities in patien with Graves's ophthalmopathy: effect of cyclophosphamide // Clin. Endocrinol. 1979. V. 10 (1). P. 79–91.Weetman A.P., Ludagte M., Mills P.V. et al. Cyclosporine improves Graves` ophtalmopathy. Lancet. 1983. V. 3. P. 486–489.Weetman A.P., Ludagte M., Mills P.V. et al. Cyclosporine improves Graves` ophtalmopathy. Lancet. 1983. V. 3. P. 486–489.Wiersinga W.M., Bartalena L. Epidemiology and prevention of Graves` ophtalmopathy // Thyroid. 2002. V. 12. P. 855–860.Wiersinga W.M., Bartalena L. Epidemiology and prevention of Graves` ophtalmopathy // Thyroid. 2002. V. 12. P. 855–860.

The authors declare that there are no conflicts of interest present.