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首页> 外文期刊>Acta endocrinologica >The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy
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The 2021 European Group on Graves’ orbitopathy (EUGOGO) clinical practice guidelines for the medical management of Graves’ orbitopathy

机译：2021年欧洲群体对Graves的胰腺炎（Eugogo）的临床实践指南，用于坟墓的医学管理

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Graves’ orbitopathy (GO) is the main extrathyroidal manifestation of Graves’ disease (GD). Choice of treatment should be based on the assessment of clinical activity and severity of GO. Early referral to specialized centers is fundamental for most patients with GO. Risk factors include smoking, thyroid dysfunction, high serum level of thyrotropin receptor antibodies, radioactive iodine (RAI) treatment, and hypercholesterolemia. In mild and active GO, control of risk factors, local treatments, and selenium (selenium-deficient areas) are usually sufficient; if RAI treatment is selected to manage GD, low-dose oral prednisone prophylaxis is needed, especially if risk factors coexist. For both active moderate-to-severe and sight-threatening GO, antithyroid drugs are preferred when managing Graves’ hyperthyroidism. In moderate-to-severe and active GO i.v. glucocorticoids are more effective and better tolerated than oral glucocorticoids. Based on current evidence and efficacy/safety profile, costs and reimbursement, drug availability, long-term effectiveness, and patient choice after extensive counseling, a combination of i.v. methylprednisolone and mycophenolate sodium is recommended as first-line treatment. A cumulative dose of 4.5 g of i.v. methylprednisolone in 12 weekly infusions is the optimal regimen. Alternatively, higher cumulative doses not exceeding 8 g can be used as monotherapy in most severe cases and constant/inconstant diplopia. Second-line treatments for moderate-to-severe and active GO include (a) the second course of i.v. methylprednisolone (7.5 g) subsequent to careful ophthalmic and biochemical evaluation, (b) oral prednisone/prednisolone combined with either cyclosporine or azathioprine; (c) orbital radiotherapy combined with oral or i.v. glucocorticoids, (d) teprotumumab; (e) rituximab and (f) tocilizumab. Sight-threatening GO is treated with several high single doses of i.v. methylprednisolone per week and, if unresponsive, with urgent orbital decompression. Rehabilitative surgery (orbital decompression, squint, and eyelid surgery) is indicated for inactive residual GO manifestations.
机译：Graves'胰腺肿（GO）是Graves疾病（GD）的主要脱滴虫表现。治疗的选择应基于对临床活动的评估和转向的严重程度。早期转诊到专门的中心是大多数患者的基础。风险因素包括吸烟，甲状腺功能障碍，高血清血清酮受体抗体，放射性碘（RAI）治疗和高胆固醇血症。在温和和活跃的情况下，控制风险因素，局部治疗和硒（硒缺乏区域）的控制通常是足够的;如果选择RAI处理来管理GD，则需要低剂量口服泼尼松预防，特别是如果危险因素共存。对于有效的中度至严重和威胁性的威胁性的GO，在管理坟墓的甲状腺功能亢进中时，抗胆汁药是优选的。在中度到严重和活跃的GO I.v.糖皮质激素比口腔糖皮质激素更有效和更好地耐受。基于当前证据和疗效/安全概况，成本和报销，饮品可用性，长期有效性和患者选择在广泛的咨询后，即I.v的组合。推荐甲基丙酮和霉酚酸钠作为一线治疗。累积剂量为4.5g i.v. 12个每周输注中的甲基丙基甲酮是最佳方案。或者，较高的累积剂量不超过8g，可以用作最严重的病例和恒定/不全的复源性的单疗法。中度至严重和活跃的二线治疗包括（a）第二课程。在仔细的眼科和生化评价之后甲基己酮（7.5g），（b）口服泼尼松/泼尼松龙与环孢菌素或副唑唑啉联合; （c）轨道放疗与口腔或i.v联合使用。糖皮质激素，（D）Teprotumumab; （e）rituximab和（f）康密菌。威胁威胁的Go是用几种高单剂量的i.v治疗。每周甲基丙酮，如果没有反应，紧急轨道减压。康复手术（轨道减压，斜壁和眼睑手术）被指示用于非活动的残留GO表现形式。

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