在英国,临床甲状腺功能亢进症的女性发病率为每年 0.8/1000,而男性发病率很低。[14]Vanderpump MP, Tunbridge WM, French JM, et al. The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol (Oxf). 1995 Jul;43(1):55-68.http://www.ncbi.nlm.nih.gov/pubmed/7641412?tool=bestpractice.com 在世界大部分地区Graves 病是甲状腺功能亢进症的最常见类型。[15]Wiersinga WM, Bartalena L. Epidemiology and prevention of Graves' ophthalmopathy. Thyroid. 2002Oct;12(10):855-60.http://www.ncbi.nlm.nih.gov/pubmed/12487767?tool=bestpractice.com[16]Laurberg P, Jorgensen T, Perrild H, et al. The Danish investigation on iodine intake and thyroid disease, DanThyr: status and perspectives. Eur J Endocrinol. 2006 Aug;155(2):219-28.http://www.ncbi.nlm.nih.gov/pubmed/16868134?tool=bestpractice.com[17]Bartley GB, Fatourechi V, Kadrmas EF, et al. Chronology of Graves' ophthalmopathy in an incidence cohort. Am J Ophthalmol. 1996 Apr;121(4):426-34.http://www.ncbi.nlm.nih.gov/pubmed/8604736?tool=bestpractice.com 在碘缺乏地区和出现地方性甲状腺肿的地区,毒性多结节性甲状腺肿更为常见,在老年人群中尤其如此。[16]Laurberg P, Jorgensen T, Perrild H, et al. The Danish investigation on iodine intake and thyroid disease, DanThyr: status and perspectives. Eur J Endocrinol. 2006 Aug;155(2):219-28.http://www.ncbi.nlm.nih.gov/pubmed/16868134?tool=bestpractice.com 英格兰的 Whickham 研究显示,甲状腺功能亢进的年发病率为 0.5 例/1000 人,发病高峰期在 40 至 60 岁。[18]Tunbridge WM, Evered DE, Hall R, et al. The spectrum of thyroid disease in a community: The Wickham Survey. Clin Endocrinol (Oxf). 1977 Dec;7(6):481-93.http://www.ncbi.nlm.nih.gov/pubmed/598014?tool=bestpractice.com 在瑞典碘充足的地区,Graves 病的年发病率为 2.1 例/1000 人,是导致≤80 岁人群患甲状腺功能亢进的主要原因。[19]Nyström HF, Jansson S, Berg G. Incidence rate and clinical features of hyperthyroidism in a long-term iodine sufficient area of Sweden (Gothenburg) 2003-2005. Clin Endocrinol (Oxf). 2013 May;78(5):768-76.http://www.ncbi.nlm.nih.gov/pubmed/23421407?tool=bestpractice.com在所有亚临床甲状腺功能亢进患者中,大约 6% 的患者病因是 Graves 病。[19]Nyström HF, Jansson S, Berg G. Incidence rate and clinical features of hyperthyroidism in a long-term iodine sufficient area of Sweden (Gothenburg) 2003-2005. Clin Endocrinol (Oxf). 2013 May;78(5):768-76.http://www.ncbi.nlm.nih.gov/pubmed/23421407?tool=bestpractice.com[20]Zhyzhneuskaya S, Addison C, Tsatlidis V, et al. The natural history of subclinical hyperthyroidism in Graves' disease: the rule of thirds. Thyroid. 2016 Jun;26(6):765-9.http://www.ncbi.nlm.nih.gov/pubmed/27090092?tool=bestpractice.com在美国,Graves 病是继桥本氏甲状腺炎之后第二位最常见的自身免疫性甲状腺疾病。女性的发病率是男性的 4 至 9 倍。Graves 病的患病率在白人和亚裔人群中相似,而在黑人中较低。[21]Lazarus JH. Epidemiology of Graves' orbitopathy (GO) and relationship with thyroid disease. Best Pract Res Clin Endocrinol Metab. 2012 Jun;26(3):273-9.http://www.ncbi.nlm.nih.gov/pubmed/22632364?tool=bestpractice.com 大约 25% 的 Graves 病患者有临床眼眶病。[1]Tanda ML, Piantanida E, Liparulo L, et al. Prevalence and natural history of Graves' orbitopathy in a large series of patients with newly diagnosed graves' hyperthyroidism seen at a single center. J Clin Endocrinol Metab. 2013 Apr;98(4):1443-9.https://academic.oup.com/jcem/article/98/4/1443/2536784http://www.ncbi.nlm.nih.gov/pubmed/23408569?tool=bestpractice.com 然而,不易察觉的亚临床 Graves 眼病的发生率可能更高。[15]Wiersinga WM, Bartalena L. Epidemiology and prevention of Graves' ophthalmopathy. Thyroid. 2002Oct;12(10):855-60.http://www.ncbi.nlm.nih.gov/pubmed/12487767?tool=bestpractice.com 在有眼眶病的患者中,4% 至 12% 的患者出现胫前黏液性水肿。[5]Fatourechi V. Pretibial myxedema: pathophysiology and treatment options. Am J Clin Dermatol. 2005;6(5):295-309.http://www.ncbi.nlm.nih.gov/pubmed/16252929?tool=bestpractice.com[13]Bartley GB, Fatourechi V, Kadrmas EF, et al. Clinical features of Graves' ophthalmopathy in an incidence cohort. Am J Ophthalmol. 1996 Mar;121(3):284-90.http://www.ncbi.nlm.nih.gov/pubmed/8597271?tool=bestpractice.com[22]Fatourechi V, Pajouhi M, Fransway AF. Dermopathy of Graves disease (pretibial myxedema): review of 150 cases. Medicine. 1994 Jan;73(1):1-7.http://www.ncbi.nlm.nih.gov/pubmed/8309359?tool=bestpractice.com 在瑞典,Graves 眼病的年发病率为 210 例/1,000,000 人。[23]Abraham-Nordling M, Byström K, Törring O, et al. Incidence of hyperthyroidism in Sweden. Eur J Endocrinol. 2011 Dec;165(6):899-905.http://www.eje-online.org/content/165/6/899.longhttp://www.ncbi.nlm.nih.gov/pubmed/21908653?tool=bestpractice.com 来自 PREGO(Graves 眼眶病的表现)研究的结果提示,过去十年期间,欧洲的 Graves 眼眶病发生率和严重程度都有下降。[24]Perros P, Žarković M, Azzolini C, et al. PREGO (presentation of Graves' orbitopathy) study: changes in referral patterns to European Group On Graves' Orbitopathy (EUGOGO) centres over the period from 2000 to 2012. Br J Ophthalmol. 2015 Nov;99(11):1531-5.http://www.ncbi.nlm.nih.gov/pubmed/25953846?tool=bestpractice.com
[Figure caption and citation for the preceding image starts]: 眼睑回缩、轻度眼球突出和轻度球结膜水肿Vahab Fatourechi 医生提供 [Citation ends].
[Figure caption and citation for the preceding image starts]: 胫前粘液性水肿(非凹陷性)Vahab Fatourechi 医生提供 [Citation ends].