葛瑞夫茲氏眼病變－從致病機轉到處理

Graves' Ophthalmopathy: From Pathogenesis to Management

張天鈞(Tien-Chun Chang)

《內科學誌》 24卷4期 (2013/08) Pp. 258-264

https://doi.org/10.6314/JIMT.2013.24(4).03

摘要

甲狀腺機能亢進症、葛瑞夫茲氏眼病變和脛前黏液水腫是葛瑞夫茲氏病的三大表徵。甲促素（TSH）受器抗體刺激甲狀腺濾泡細胞的甲促素受器，導致甲狀腺荷爾蒙的過度製造，而產生甲狀腺機能亢進症。至於眼病變和脛前黏液水腫的原因，雖較不清楚，但目前已知葛瑞夫茲氏眼病變是一種自體免疫疾病。可能是血中可以和甲促素受器作用的T細胞，與眼窩組織的脂肪細胞和成纖維細胞上的甲促素受器作用，然後分泌細胞激素，刺激成纖維細胞分泌黏多糖（glycosaminoglycan）。而黏多糖可以吸收水分，使得眼肌肉和眼球後組織的體積漲大。在處理方面，電腦斷層攝影是標準的檢查方法。此外，要評估其活動性，若是活動的，則可給予高劑量腎上腺皮質類固醇。若已不具活動性，但仍有症狀，則可考慮手術。而且要能隨時保持甲狀腺功能在正常範圍。總之，葛瑞夫茲氏眼病變的處理，是跨科的，必須有好的團隊合作，才能讓病人得到最好的治療。

關鍵字

葛瑞夫茲氏眼病變 ； 葛瑞夫茲氏病 ； 黏多糖 ； 電腦斷層攝影

並列摘要

Hyperthyroidism, Graves' ophthalmopathy and pretibial myxedema are three major manifestations of Graves' disease. TSH receptor antibody stimulates TSH receptors on the follicular cells of the thyroid to over produce thyroid hormones, resulting hyperthyroidism. However, the etiology of Graves' ophthalmopathy and pretibial myxedema is not so clear. It is quite clear that Graves' ophthalmopathy is an autoimmune disease. It may be related to the action of T cells with TSH receptors on retrobulbar fibroblasts and adipocytes, and T cells produce cytokines to stimulate fibroblasts to secrete glycosaminoglycans which absorb water to make swelling of extraocular muscles and retrobulbar tissues. Orbital computed tomography is an important method to examine Graves' ophthalmopathy. In addition, the activity of Graves' ophthalmopathy should be evaluated. If it is in active stage, high dose of corticosteroid could be used. If it is inactive, but still symptomatic, surgery may be necessary. The patient should be kept in euthyroid state at any stage. In conclusion, the management of Graves' ophthalmopathy should be managed by team work to get the best result.

並列關鍵字

Graves' ophthalmopathy ； Graves' disease ； Glycosaminoglycan ； Computed tomography