갑상샘눈병증 환자에서 고용량 스테로이드 주사 치료 후 임상 양상 및 자가항체 수치 변화
Clinical Changes and Autoantibody Level Changes in Thyroid Eye Disease Patients after Intravenous High-dose Steroid therapy
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 고용량 스테로이드 주사 후 임상 활동도 점수(clinical activity score, CAS), 안구돌출도, 눈꺼풀각막반사간거리1 (margin-reflex distance 1, MRD1), 자가항체 수치 변화를 확인하고자 하였다. 대상과 방법: 갑상샘눈병증 진단 후 고용량 정맥 스테로이드 주사한 83명의 환자에 대해 후향적 연구가 이루어졌다. 안구돌출도, MRD1, CAS, 갑상샘자극항체(thyroid-stimulating antibody, TSAb), 갑상샘자극호르몬수용체항체(thyroid-stimulating hormone receptor antibody, TSHR Ab)는 치료 시작 전 기저 수치, 치료 시작 6주, 12주 후, 치료 종료 2개월 후 평가되었다. 또한 기저 혈청 셀레늄수치가 치료 예후와의 관계를 확인하기 위해 평가되었다. 결과: TSAb, TSHRAb 그리고 CAS는 치료 종료 2개월 후까지 지속적인 감소를 보였으며, 각각 443.2 specimen-to-reference control ratio (SRR%)에서 341.03 SRR%, 22.18 IU/L에서 7.91 IU/L, 3.37에서 1.88 (p<0.0001)로 나타났다. 안구돌출도는 기저 수치와비교하여 유의미한 효과를 보이는 시점은 없었으며, MRD1은 치료 시작 12주째 감소를 보였으나, 치료 종료 2개월 후에는 차이가 확인되지 않았다. 기저 혈청 셀레늄 수치와 안구돌출도, MRD1, TSAb, TSHR Ab, CAS의 변화 간 상관관계는 보이지 않았다. 결론: 고용량 정맥 스테로이드 치료는 TSAb, TSHR Ab 및 CAS의 개선에 있어 효과적이며 치료 종료 2개월째까지도 지속된 효과를보여준다. 하지만 눈꺼풀뒤당김 및 안구돌출도의 완화 측면에 있어서는 한계가 확인되며, 기저 셀레늄 수치는 임상 양상 변화와 상관관계를 보이지 않았다.
Abstract
Purpose: To evaluate the effects of intravenous steroid therapy on the clinical activity score (CAS), exophthalmos, margin-reflex distance 1 (MRD1), and autoantibody levels in patients with thyroid eye disease. Methods: In this retrospective observational study, we enrolled 83 patients diagnosed with thyroid eye disease treated with intravenous steroid therapy. We assessed exophthalmos, MRD1, CAS, thyroid-stimulating antibody (TSAb), and thyroid-stimulating hormone receptor antibody (TSHR Ab) levels at baseline, 6 and 12 weeks after initiating therapy, and 2 months after therapy termination. Additionally, baseline serum selenium levels were examined to determine their impact on treatment efficacy. Results: TSAb, TSHRAb, and CAS levels showed a continuous decline from 443.22 to 341.03 specimen-to-reference control ratio (SRR%), 22.18 to 7.91 IU/L, and 3.37 to 1.88, respectively (p < 0.0001), up to 2 months following therapy termination. Exophthalmos did not show significant changes at any assessed time point up to 2 months after therapy termination. MRD1 decreased until 12 weeks after therapy initiation but showed no significant change 2 months later. No correlation was found between baseline serum selenium levels and changes in exophthalmos, MRD1, TSAb, TSHR Ab, or CAS. Conclusions: Intravenous steroid therapy was effective in reducing TSAb, TSHR Ab, and CAS levels up to 2 months after therapy termination. However, it had limited positive impact on exophthalmos or eyelid retraction. Baseline selenium levels did not correlate with the changes in any of the examined parameters.
참고문헌 (30)
- Hoang TD, "2022 update on clinical management of graves disease and thyroid eye disease", Endocrinol Metab Clin North Am, 51, pp.287~304 (2022)
- Phelps PO, "Thyroid eye disease for the primary care physician", Dis Mon, 60, pp.292~298 (2014)
- Bahn RS, "Graves' ophthalmopathy", N Engl J Med, 362, pp.726~738 (2010)
- Lytton S, "A novel thyroid stimulating immunoglobulin bioassay is a functional indicator of activity and severity of Graves’ orbitopathy", J Clin Endocrinol Metab, 95, pp.2123~2131 (2010)
- Kahaly GJ, "TSH receptor antibodies : relevance & utility", Endocr Pract, 26, pp.97~106 (2020)
- George A, "Stimulatory thyrotropin receptor antibodies are a biomarker for Graves' orbitopathy", Front Endocrinol(Lausanne), 11, pp.629925~ (2020)
- Bartalena L, "The 2021 European Group on Graves’ orbitopathy(EUGOGO)clinical practice guidelines for the medical management of Graves’ orbitopathy", Eur J Endocrinol, 185, pp.G43~G67 (2021)
- Ventura M, "Selenium and thyroid disease : from pathophysiology to treatment", Int J Endocrinol, 2017, pp.1297658~ (2017)
- Marcocci C, "Selenium and the course of mild Graves' orbitopathy", N Engl J Med, 364, pp.1920~1931 (2011)
- Wertenbruch T, "Serum selenium levels in patients with remission and relapse of Graves' disease", Med Chem, 3, pp.281~284 (2007)
- Kahaly GJ, "Thyroid stimulating antibodies are highly prevalent in Hashimoto's thyroiditis and associated orbitopathy", J Clin Endocrinol Metab, 101, pp.1998~2004 (2016)
- Bartalena L, "Glucocorticoid therapy of Graves' ophthalmopathy", Exp Clin Endocrinol, 97, pp.320~327 (1991)
- Kahaly GJ, "Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves’ orbitopathy", J Clin Endocrinol Metab, 90, pp.5234~5240 (2005)
- Alkawas AA, "Orbital steroid injection versus oral steroid therapy in management of thyroid-related ophthalmopathy", Clin Exp Ophthalmol, 38, pp.692~697 (2010)
- Ohtsuka K, "Effect of high-dose intravenous steroid pulse therapy followed by 3-month oral steroid therapy for Graves' ophthalmopathy", Jpn J Ophthalmol, 46, pp.563~567 (2002)
- Lee J, "Changes in clinical activity, serum autoantibody levels, and chorioretinal vessels after systemic glucocorticoid therapy in thyroid eye disease", Ophthalmol Ther, 12, pp.1851~1863 (2023)
- Bartalena L, "Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves' orbitopathy", J Clin Endocrinol Metab, 97, pp.4454~4463 (2012)
- Shin DY, "Clinical implication of TSH receptor antibody measurement", Int J Thyroidol, 9, pp.15~18 (2016)
- Eckstein AK, "Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease", J Clin Endocrinol Metab, 91, pp.3464~3470 (2006)
- Noh JY, "Thyroid-stimulating antibody is related to Graves' ophthalmopathy, but thyrotropin-binding inhibitor immunoglobulin is related to hyperthyroidism in patients with Graves' disease", Thyroid, 10, pp.809~813 (2000)
- Cirić J, "Treatment of Grave's ophthalmopathy with high doses of corticosteroids", Srp Arh Celok Lek, 128, pp.179~183 (2000)
- van Geest RJ, "Methylprednisolone pulse therapy for patients with moderately severe Graves' orbitopathy : a prospective, randomized, placebo-controlled study", Eur J Endocrinol, 158, pp.229~237 (2008)
- Lee DC, "Course of upper eyelid retraction in thyroid eye disease", Br J Ophthalmol, 104, pp.254~259 (2020)
- Bagheri A, "Intraorbital steroid injection for active thyroid ophthalmopathy", J Ophthalmic Vis Res, 15, pp.69~77 (2020)
- Young SM, "Transconjunctival triamcinolone injection for upper lid retraction in thyroid eye disease-a new injection method", Ophthalmic Plast Reconstr Surg, 34, pp.587~593 (2018)
- Chee E, "Subconjunctival injection of triamcinolone in the treatment of lid retraction of patients with thyroid eye disease : a case series", Eye(Lond), 22, pp.311~315 (2008)
- Ahn HY, "Intravenous glucocorticoid treatment for Korean Graves' ophthalmopathy patients", J Korean Med Sci, 35, pp.e177~ (2020)
- van Zuuren EJ, "Selenium supplementation for hashimoto's thyroiditis : summary of a cochrane systematic review", Eur Thyroid J, 3, pp.25~31 (2014)
- Dehina N, "Lack of association between selenium status and disease severity and activity in patients with Graves' ophthalmopathy", Eur Thyroid J, 5, pp.57~64 (2016)
- Chung CW, "Efficacy of selenium supplementation for mild-to-moderate Graves' ophthalmopathy in a selenium-sufficient area(SeGOSS trial) : study protocol for a phase III, multicenter, open-label, randomized, controlled intervention trial", Trials, 24, pp.272~ (2023)