八、展望
GO是GD最常见的甲状腺外表现，总体人群中仍然属于少见疾病。但是，即使是轻度GO对患者的生活质量也会带来很大负面影响。GO的防治目标是：最大限度地减少GO发病率，预防高风险个体发生GO，改善GO患者的生活质量。因此，应早期诊断和治疗Graves病，认识GO及GO高风险患者。选择合适的方案治疗GD的甲状腺功能异常，维持甲状腺功能平稳正常。接受放射性碘治疗的患者，对于已患GO或GO高风险者，推荐给予小剂量糖皮质激素预防GO发生或加重，同时注意防治放射碘治疗后的甲减。采取戒烟措施，使用温和的抗氧化剂（硒）。中重度及威胁视力的GO仍然是治疗难点，虽然对GO发病机制的认识已经有了很大进步，但仍然缺乏精准靶向致病机制的治疗。随机临床试验使GO的糖皮质激素治疗、眶后放射治疗等方案不断得以优化。新型生物制剂，如利妥昔单抗以及其他药物（例如托珠单抗或抗IGF-1受体单克隆抗体）等的疗效、适应证和安全性有待大型随机对照研究的结果。
图26-6 GO诊疗流程图
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