Читать книгу Graves' Orbitopathy - Группа авторов - Страница 55

Graves’ orbitopathy (GO) is a relatively rare disease. There are a few studies on its incidence, but prevalence data are lacking and can only be estimated. The incidence of GO in the general population of Olmsted County in Minnesota, USA, has been reported as 16 women and 3 men per 100,000 population per year [1]. Based on the incidence of Graves’ hyperthyroidism in a Swedish population, the incidence of GO was 42/100,000/year (32 and 10 per 100,000 per year for mild and moderate-to-severe GO, respectively) [2]. About two thirds of all GO patients have just mild GO. The incidence of moderate-to-severe GO will thus be much lower. In a population-based study in Denmark performed between 1992 and 2009, the incidence of moderate-to-severe GO was 1.61/100,000/year (2.67 in women, 0.54 in men); it was similar before and after mandatory salt iodization [3]. The incidence peaked in the age group of 40–60 years. The overall prevalence of GO is estimated to be about 90/100,000 population (60/100,000 for mild and 30/100,000 for moderate-to-severe GO) [4].

The occurrence of moderate-to-severe GO (including dysthyroid optic neuropathy) in patients with Graves’ hyperthyroidism is about 5% (4.9% in population-based surveys in Sweden and Denmark, and 6.1% in a single-centre study from Italy) [2–5]. It means that 1 out of 20 patients with Graves’ hyperthyroidism will have or develop significant GO. At diagnosis of Graves’ hyperthyroidism, the majority of patients (74%) has no GO, and in this group only 3% will develop moderate-to-severe GO during an 18-month follow-up (when treated with antithyroid drugs) [5]. Mild GO is present in 20% of patients when diagnosed with Graves’ hyperthyroidism, and, most interestingly in this group after 18 months of follow-up, mild GO is still present in 40% but GO has disappeared in 55% (Fig. 1) [5].

Fig. 1. Prevalence of Graves’ orbitopathy (GO) in 346 consecutive patients with newly diagnosed Graves’ hyperthyroidism, who were followed up for 18 months during treatment with antithyroid drugs. a Total prevalence of GO. b No GO at baseline (n = 194). c Mild GO at baseline (n = 43). Modified from Tanda et al. [5].