ステロイドパルス療法と放射線療法の併用療法が奏効した甲状腺眼症の3例

Treatment with radiation and pulsed corticosteroid was effective in three cases of dysthyroid ophthalmopathy

発症から5か月以内の甲状腺眼症の3例をステロイドパルス療法と放射線照射で治療した。40歳女性，71歳女性，81歳男性で，3例とも複視を訴え，甲状腺刺激抗体が高値であった。2例に甲状腺機能亢進があり，1例は甲状腺機能正常であった。2例に眼球突出と眼球運動障害があり，1例には視力障害と視神経症があった。磁気共鳴画像検査（MRI）で外眼筋が著明に肥大し，外眼筋内に高信号があった。治療により，全例で視力障害，眼球突出，眼球運動障害，視神経症が改善し，それぞれ9か月，27か月，53か月の経過観察で再発はない。ステロイドパルス療法と放射線照射の併用は，甲状腺眼症の活動期に対する保存的治療として有効であった。

We treated 3 cases of dysthyroid ophthalmopathy by radiation and pulsed corticosteroid. The series comprised two females and one male aged 40,71 and 81 years respectively. Diplopia was the chief complaint in all the cases. All the cases showed elevated thyroid-stimulating antibody. Two had hyperthyroidism and one had euthyroidism. Two patients showed proptosis and impaired ocular movement. One showed decreased visual acuity and optic neuropathy. Extraocular muscles were hypertrophic and showed high intensity by magnetic resonance imaging（MRI）. All the cases responded to treatment resulting in improvement of visual acuity,proptosis,ocular motility disorder,and optic neuropathy. There has been no recurrence during the follow-up for 9,27 and 53months respectively. These cases show that radiation and pulsed corticosteroid may be effective for dysthyroid ophthalmopathy when treated within 5months after onset.