医学
重症监护医学
甲状腺炎
疾病
模式
临床试验
甲状腺
特拉布
免疫系统
从长凳到床边
甲状腺疾病
生活质量(医疗保健)
治疗方式
免疫学
格雷夫斯病
免疫疗法
生物信息学
疾病管理
自身免疫
规范化(社会学)
作者
Marius N. Stan,David Toro-Tobon
标识
DOI:10.1210/clinem/dgag010
摘要
Graves' disease (GD) is an autoimmune entity that had an unchanged treatment paradigm for more than half a century with radioactive iodine, antithyroid drugs (ATDs), and surgery representing the mainstay of therapy, with variation in their use over time and geographic location. Hypothyroidism has been an accepted tradeoff in many cases, though recently there are increased concerns about altered quality of life in these patients. Fortunately, the last decade has seen an intense pursuit of GD's immunological mechanisms and a recalibration of classic treatment modalities focusing on thyroid preservation, as reflected in the preference for ATD as primary therapy, including its use in long-term protocols. The immune targets currently explored aim to address this gap by intervening in the TRAb lifecycle: minimizing production (eg, B-cell targeting), enhancing clearance (eg, neonatal Fc receptor inhibitors), or neutralizing its target-the TSH receptor (eg, receptor blockade). While these approaches are going through the necessary clinical trials evaluation, we are starting to see the potential for technology and artificial intelligence to make an impact on how we identify, treat, and monitor patients with GD. The combination of these approaches will likely lead to a significant individualization of GD management that will take us from the goal of normalization of thyroid levels to that of inducing long-term remission and prevention of the associated autoimmune phenomena that GD is associated with. While time is needed for these aspects to mature, the future looks bright for our GD patients and maybe soon these lessons will open new doors for our patients with Hashimoto's thyroiditis as well.
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