Słowa kluczowe
orbitopatia tarczycowa
tyreotoksykoza
nowe terapie
Jak cytować
Abstrakt
Choroba Gravesa i Basedowa stanowi najczęstszą przyczynę nadczynności tarczycy w krajach o prawidłowej podaży jodu, a jej główną pozatarczycową manifestacją jest orbitopatia tarczycowa. Od wielu lat w leczeniu tyreotoksykozy stosuje się tyreostatyki, terapię jodem promieniotwórczym oraz tyreoidektomię, a standardem leczenia tarczycowej choroby oczu pozostają glikokortykosteroidy. Obecnie widoczny jest rosnący trend stosowania terapii celowanych w leczeniu orbitopatii tarczycowej. Znaczący rozwój immunobiologii, lepsze zrozumienie patofizjologii choroby i mnogość badań nad nowymi terapiami dają nadzieję na lepsze wyniki leczenia i poprawę jakości życia pacjentów.
Celem pracy jest omówienie aktualnych zasad postępowania w chorobie Gravesa i Basedowa, w tym orbitopatii tarczycowej, ze szczególnym uwzględnieniem nowych metod terapeutycznych. Wskazujemy potencjalną rolę K1-70TM i drobnocząsteczkowych antagonistów receptora TSH w leczeniu hipertyreozy. Przedstawiamy obiecujące efekty połączenia glikokortykosteroidów z mykofenolanami, a także uwzględniamy zastosowanie teprotumumabu, rituximabu, cyklosporyny A, azatiopryny, metotreksatu, tocilizumabu i sirolimusu w terapii aktywnej umiarkowanej do ciężkiej postaci orbitopatii. Zauważamy ochronny i wspomagający wpływ statyn w leczeniu tarczycowej choroby oczu. Dostrzegamy ograniczenia przytoczonych wyników badań i podkreślamy potrzebę dalszych, randomizowanych badań nad długoterminowym bezpieczeństwem i skutecznością terapii wśród większej grupy pacjentów.
Bibliografia
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