甲状腺眼症診療の手引き - j-endo.jp

1 Digest .. 1.. 2.. 2011 9 . 1 .. 2018 3 2018 2 . 2020 6 . Digest . PDF .. 3.. QOL . MRI .. Clinical Question . CQ1 . 4.. quality of life (QOL) .. Graefe .. IgG4 . MALT MALT lymphoma . extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type pyocele mucocele - .. Graves' ophthalmopathy GO . Graves' orbitopathy GO Thyroid-associated ophthalmopathy TAO Thyroid eye disease (TED) Dysthyroid ophthalmopathy (DO) Dysthyroid orbitopathy (DO) .. M ller .. TSH .. 5. Euthyroid Graves' disease hypothyroid Graves' disease . euthyroid Graves'. disease hypothyroid Graves' disease TRAb TSAb .. Occult thyroid eye disease . magnetic resonance imaging (MRI) .. TSH insulin like growth factor 1 (IGF-1) . TSH CTLA-4 PTPN22 CD40 T. regulatory T cells (Treg) Forkhead box P3 (FOXP3) . CD34+ TSH . TSH interleukin (IL)-6 IL-8 tumor necrosis factor (TNF)- . CD34- IGF-1 IGF-1 . IL-16 RANTES IL-1 prostaglandin e2 . T CD90+ transforming growth factor(TGF)- myofibroblast.

2 M ller .. QOL .. 1 .. 6.. 1 2 . 1 2 . 1 2 .. euthyroid Graves' disease hypothyroid Graves' disease .. HbA1c 75gOGTT . IFN- T-spot QFT-3G HBs HBs HBc HCV X BMI>25.. 7.. MRI CT .. 3 .. dysthyroid optic neuropathy DON / .. QOL . 1 . 2mm .. 18mm . ( .. 2mm .. 15 18 . MRI . 8.. (NOSPECS) (0) (a) (b) (c). 0 No physical signs or symptoms Only signs, no . I symptoms (lid 8 10mm 10 12mm 12mm . retraction, lid lag) mm . Soft tissue involvement (sandy .. sensation, lacrimation, . II photophobia, lid fullness, conjunctival injection, chemosis, lid . edema). III Proptosis 15mm 15 18mm 18 21mm 21mm . Extraocular muscle IV involvement .. V C orneal involvement .. Sight loss (optic nerve . VI involvement) .. Clinical activity score (CAS). CAS 1 .. CAS 10 4 . 1 . Clinical activity score (CAS).. 1 3 mm . 1 3 8 . 1 3 .. Mourits .. 9. quality of life (QOL). quality of life (QOL).. 1 2 3 .. ( - )/ x 100= % (0 100% ). QOL .. MRI . MRI . T1 .. T2 T2 T2 .. 10. Signal intensity ratio T2 short TI inversion recovery STIR.)

3 / .. T2 .. T1 T2 STIR T2 STIR.. T1 .. MRI .. 3 .. T1 MRI . ROI 4 . mm .. T2 T2-relaxation time . TR TE MRI 5 . 11.. STIR . 6 . 75 . 2. 3 4 . TE TE . 20 90 . 3. 5 T2 T2-relaxation time .. 6 . T1 . STIR .. 12.. 7 .. 131 . 131 10-15 . 131.. TRAb TSA .. A .. B .. C .. TRAb TSAb T3 T .. 13.. 2 .. / 3 . 3 .. Daily / 3 3 . 1 . weekly 1 6 . 1 6 1 .. 77 .. HbA1c 75gOGTT . IFN- T-spot QFT-3G HBs HBs HBc HCV. HZV HSV X . BMI>25 .. EUGOGO. 8 .. 14. 480 19 4 AST ALT>100 U/L . 175 . 35 6 4 .. EUGOGO 8 . 8 . HBs HBc HBs . HBV-DNA HBV HBV HBV .. 8g HBV . B 2019 3 .. 3 6 .. H2 .. 35 .. 2 1 Gy 10 15 20 Gy 2 . 30 Gy . 10 Gy . 59 RCT 44 .. 15-30mg .. 88 .. 1 .. 15.. 8 .. EUGOGO MRI MRI.. MRI .. ( ) .. rituximab . tocilizumab teprotumumab . 2020 1 21 . FDA .. 16.. GO-QOL 6 . 6 .. CAS 2 . O 2mm . S 1 . P 2mm . E 1 . 1 . S . MRI .. T2 . STIR T2 .. 3 .. 17. Clinical Question . CQ1 . A . A . RI A . A .. 1 A .. 1 . TSH 9 . 10 .. U/mL . FT4 FT3 . 12 .. 11 . 12 .. Th1 Th17.

4 2 .. 3mL . 1mL 13 . -15 .. 1 . 16 .. Basedow 1 . 7 . Base- dow . Basedow 17 .. 3 . -5 . Basedow . 73 . -11 .. 5 . 6 . 7 . 8 . 18. 7 . 1 3 4 5. 2 5 6. RI . 3 RCT 7 8. RCT. 4 9 10.. 5 11. 3 11 .. 1 Wiersinga WM. Smoking and thyroid. Clin 11 Pfeilschifter J, Ziegler R. Smoking and endocrine Endocrinol Oxf . 2013 79 145-51. ophthalmopathy impact of smoking severity and 2 Wang DW, Zhou RB, Yao YM, et al. Stimulation of current vs lifetime cigarette consumption. Clin 7 nicotinic acetylcholine receptor by nicotine Endocrinol Oxf . 1996 45 477-81. increases suppressive capacity of naturally 12 Vestergaard P. Smoking and thyroid disorders--a occurring CD4+CD25+ regulatory T cells in mice J Endocrinol. 2002 146 . in vitro. J Pharmacol Exp Ther. 2010 335 553-61. 153-61. 3 H gg E, Asplund K. Is endocrine ophthalmopathy 13) Metcalfe RA, Weetman AP. Stimulation of related to smoking? Br Med J Clin Res Ed . extraocular muscle fibroblasts by cytokines and 1987 295 634-5.

5 Hypoxia possible role in thyroid-associated 4 Bartalena L, Martino E, Marcocci C, et al. More ophthalmopathy. Clin Endocrinol Oxf .1994 . on smoking habits and Graves' ophthalmopathy. J 40 67 72. Endocrinol 12 733-7. 14 Chng CL, Lai OF, Chew CS, et al. Hypoxia increases 5 Prummel MF, Wiersinga WM. Smoking and risk of adipogenesis and affects adipocytokine Graves'disease. JAMA. 1993 269 479-82. production in orbital fibroblasts-a possible 6 explanation of the link between smoking and 2018 80 13-21. Graves' ophthalmopathy. Int J Ophthalmol. 7 Bartalena L, Marcocci C, Bogazzi F, et al. 2014 7 403 7. Relation between therapy for hyperthyroidism 15 Regensburg NI, Wiersinga WM, Berendschot TT, et and the course of Graves' Engl al. Effect of smoking on orbital fat and muscle J Med. 1998 338 73-8. volume in Graves' orbitopathy. Thyroid. 2011 . 8 Tr isk F, Tallstedt L, Abraham-Nordling M, et al. 21 177 81. Thyroidassociated ophthalmopathy after 16 Cawood TJ, Moriarty P, O'Farrelly C, et al.

6 Treatment for Graves' hyperthyroidism with Smoking and thyroid-associated antithyroid drugs or iodine-131. J Clin ophthalmopathy A novel explanation of the Endocrinol Metab. 2009 94 3700-7. biological link. J Clin Endocrinol Metab. 2007 . 9 Bartalena L, Marcocci C, Tanda ML, et al. 92 59-64. Cigarette smoking and treatment outcomes in 17 Kau HC, Wu SB, Tsai CC, et al. Cigarette smoke Graves ophthalmopathy. Ann Intern Med. 1998 extract-induced oxidative stress and 129 632-5. fibrosis-related genes expression in orbital 10 Eckstein A, Quadbeck B, Mueller G, et al. Impact fibroblasts from patients with Graves'. of smoking on the response to treatment of Med Cell Longev. 2016 . thyroid associated J 2016 4676289. Ophthalmol. 2003 87 773-6. 19.. 839-8577 120 . 0942-38-22221 Fax 0942-38-2255. E-mail 20.