Efficacy of tocilizumab in resistant forms of Thyroid Eye Disease

Thyroid Eye Disease (TED), formerly known as Graves' orbitopathy, is an autoimmune disorder affecting orbital tissues. The Clinical Activity Score (CAS) is used to evaluate TED activity. A score ≥3 indicates active disease, warranting immunomodulatory therapy. Intravenous corticosteroids (IVCS) are the first-line treatment. However, studies show 20-30% of patients with moderately severe active TED have an inadequate response to corticosteroids. For patients with poor response or tolerance to steroids, tocilizumab offers an effective alternative. We present a case of a 49-year-old female with moderately severe, active, corticosteroid-resistant TED. After failure of two corticosteroid regimens (4.5 g and 5 g), biological therapy with tocilizumab (6 cycles of 600 mg every 4 weeks) was initiated. Clinical response was monitored using NOSPECS, CAS, and the Gorman-Bahneman diplopia classification. This case confirms the potential efficacy of tocilizumab in managing corticosteroid-resistant, moderately severe active TED.