We report the case of a 60-year-old female patient, smoker, diagnosed with hypothyroidism thyroid ablation with radioactive iodine and severe GO bilateral optic neuropathy, classifying edema according to the following criteria: conjunctival edema, hypercalcemia
Visual acuity (VA) was also measured, despite not being included in the CAS criteria to assess the ability of the visual system, obtaining a VA of 0.4 in Right Eye (OD) and VA of 0.5 in Eye.
The normal VA is equal to 1.
It began with ocular symptoms 1 year before diagnosis.
The objective of the treatment was to restore euthyroidism, quit smoking and control the disease by administering corticoids at high doses intermittently weekly (6 doses of methylprednisolone 250 mg/week).
Despite this, there was little response, so it was necessary to perform bilateral orbital decompression due to worsening of VA.
However, orbitopathy continued to progress to achieve a finger VA in RE and less than 0.05 in OI, requiring a second orbital decompression.
Once all the therapeutic possibilities were exhausted, the Commission requested authorization for off-label use of Tocilizumab in this patient.
After obtaining the authorization and the corresponding informed consent, treatment was initiated with intravenous Tocilizumab at a dose of 8 mg/ kg body weight, once every 4 weeks, totaling 5 doses.
After 2 weeks from the beginning of treatment, the patient began to show an improvement in signs and symptoms of the pathology, both subjective and objective, with VA in the LE at this time equal to 0.05.
At 9 weeks, the improvement continued, showing an OI VA of 0.1, almost without signs of edema and conjunctival erythema and pebral.
At 18 weeks the VA in the LE was 0.6 and after 20 weeks of treatment the VA in the LE reached the value of 1 (normal AV).
In the RE, it was not possible to quantify the improvement at this time due to the presence of strabismus after surgery, remaining pending resolution of this pathology.
After 5 sessions with Tocilizumab, the patient has no inflammatory activity and a VA of 0.1 in RE and VA of 1 in LE without adverse effects, with a CAS score of 0 over 7.
