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Dysthyroid optic neuropathy treated with tocilizumab
Yuerong Yan1,2, Zhaoxi Cai3, Meng Ren1,2
1Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Endocrinology, Diabetes & Metabolism Case Reports
|February 22, 2025
Summary
Tocilizumab offers a potential treatment for Dysthyroid Optic Neuropathy (DON) when standard therapies like steroids are unsuitable. This interleukin-6 receptor inhibitor showed promise in a patient with Graves
Area of Science:
- Ophthalmology
- Immunology
Background:
- Dysthyroid optic neuropathy (DON) is a severe complication of Graves' orbitopathy (GO).
- Standard treatments, including high-dose steroids and surgery, are not suitable for all patients.
- Glucocorticoids are contraindicated in patients with co-existing central serous chorioretinopathy (CSC).
Purpose of the Study:
- To evaluate the efficacy and safety of tocilizumab in a patient with DON and contraindications for standard treatments.
- To explore tocilizumab as an alternative treatment for DON.
Main Methods:
- A patient with DON and CSC received intravenous tocilizumab (6 doses of 8 mg/kg every 4 weeks).
- Disease severity and inflammation were assessed.
- Magnetic resonance imaging (MRI) was used to evaluate muscle inflammation.
Main Results:
- The patient's DON improved to moderate to severe GO after tocilizumab treatment.
- MRI revealed a significant reduction in inflammation in affected muscles.
- No adverse effects were observed during the treatment period.
Conclusions:
- Tocilizumab demonstrated clinical improvement and a favorable safety profile in a DON patient unsuitable for standard therapies.
- Previous case reports and observational studies support tocilizumab's efficacy in DON.
- Tocilizumab may be a viable treatment option for DON, particularly when glucocorticoids are inappropriate, but further high-quality studies are needed.
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