Moderate-to-Severe Thyroid Eye Disease After Rituximab, Tocilizumab, or Radiotherapy: Rehabilitative Next Step
This protocol addresses patients with active moderate-to-severe Graves' orbitopathy in whom disease activity is the prominent feature — without significant proptosis or diplopia — who have progressed through active-phase immunosuppressive or radiation treatment without achieving full disease inactivation.
Active moderate-to-severe thyroid eye disease with disease activity as the dominant feature, in the absence of significant proptosis and the absence of diplopia. The eye disease has sufficient impact on daily life to justify intervention.
The preceding treatment — which included rituximab, tocilizumab, an additional course of IVGC, or radiotherapy, all targeting disease inactivation — set a goal of clinical activity score below 3. This protocol represents the next management step in the pathway once that active phase has been addressed and euthyroidism has been achieved and maintained.
References
doi: 10.1089/thy.2022.0251
- Patients without sight-threatening disease whose eye disease has sufficient impact on daily life to justify the risks of medical or surgical intervention.
- IVGC therapy is a preferred treatment for active moderate-to-severe TED when disease activity is the prominent feature in the absence of either significant proptosis (see Section 2.1. for definition) or diplopia.
- Rehabilitative surgery for moderate-to-severe TED should only be performed when the disease is inactive and euthyroidism has been achieved and maintained.
- A rare indication is to relieve longstanding soft tissue congestion.