Thyroid Eye Disease

Tocilizumab explored as second-line therapy in steroid-resistant pediatric TED

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Tocilizumab as second-line therapy was found to be an effective tool in the management of steroid-resistant thyroid eye disease (TED) in a pediatric patient, according to a case report.

When severe TED is steroid-resistant in children it can be difficult to manage. A single case report has shown the effectiveness of tocilizumab in these patients when steroids fail.

In the current case report, a 13-year-old with a history of Graves’ disease had proptosis of the right eye lasting >8 months. The patient had mild pain on eye movements and ocular surface complaints. Hertel exophthalmometry measurements were 22 mm on the right eye (OD) and 19 mm on the left (OS). There were no other remarkable ophthalmologic findings.

After 4 treatments with intravenous methylprednisolone pulses of 500 mg there was no improvement, so therapy was switched to monthly injections of 4 mg/kg tocilizumab.

Immediately after switching treatments, there was a significant reduction of proptosis and resolution of pain and ocular surface complaints.

After 4 treatments with tocilizumab exophthalmometry measurements were 20 mm on OD and 19 mm on OS.

The patient reported no side effects during the follow-up period, and 6 months post-treatment she remained stable.

Moleiro AF, Vilares-Morgado R, Alves GC, et al. Tocilizumab as a Useful Tool for Thyroid Eye Disease in Pediatric Population: A Case Report. Case Rep Ophthalmol. 2022 Nov 17;13(3):877-884. doi: 10.1159/000526546. PMID: 36466065; PMCID: PMC9710467.