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Efecto sobre la exoftalmos de varios métodos de tratamiento de la enfermedad de Graves
JAMA
|April 16, 1982
Resumen
Los tratamientos para el hipertiroidismo impactan en las complicaciones oculares de la enfermedad de Graves. El propiltiouracilo mostró un aumento en la progresión de la exoftalmia, mientras que la pérdida de tejido tiroideo por cirugía o el yodo radiactivo disminuyeron los cambios oculares.
Área de la Ciencia:
- Endocrinología Endocrinología.
- Oftalmología Oftalmología.
Sus antecedentes:
- La enfermedad de Graves se presenta con frecuencia con hipertiroidismo y exoftalmos.
- Las estrategias de tratamiento óptimas para el manejo del hipertiroidismo y la exoftalmos concurrentes siguen siendo un área de investigación.
Objetivo del estudio:
- Evaluar el impacto de diferentes modalidades de tratamiento de la hipertiroiditis en la progresión de la exoftalmos en pacientes con oftalmopatía de Graves coexistente.
Principales métodos:
- Los pacientes con hipertiroidismo y exoftalmos fueron asignados a siete grupos en función del tratamiento: propiltiouracilo (PTU) seguido de cirugía, PTU seguido de yodo radiactivo (RAI), PTU solo o RAI solo.
- El desarrollo de hipotiroidismo después del tratamiento se administró con levotiroxina sódica.
- La exoftalmometría se realizó cada seis semanas durante un período de seguimiento de 18 meses.
Principales resultados:
- La progresión de la exoftalmosis se observó en todos los grupos de tratamiento.
- La mayor progresión de exoftalmos se produjo en el grupo tratado con propiltiouracilo.
- Se observó una tasa reducida de progresión de la exoftalmosis en pacientes que desarrollaron hipotiroidismo después de RAI o tratamiento quirúrgico, lo que sugiere que la pérdida de tejido tiroideo es un factor clave.
Conclusiones:
- La ablación del tejido tiroideo, lograda a través de cirugía o yodo radiactivo, parece mitigar la progresión de la exoftalmia de manera más efectiva que el tratamiento médico con propiltiouracilo.
- Los efectos inmunomoduladores del propiltiouracilo pueden contribuir al empeoramiento observado de la exoftalmosis.
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