Results with Rituximab in Thyroid Orbitopathy

Abstract

Thyroid orbitopathy is a condition of autoimmune genesis and the main extrathyroid manifestation of Graves-Basedow disease. Steroids are the first therapeutic option, followed by radiotherapy, selenium, octeotride and others. Orbital decompression is performed in cases with severe and inactive thyroid orbitopathy. The use of biological agents such as rituximab, an anti-CD20 monoclonal antibody, which modulates the immune system, has been used successfully in some cases with steroid resistance. We present a 51-year-old patient, uncontrolled diabetic and smoker, with a history of severe left unilateral active thyroid orbitopathy. Control of diabetes and thyroid disease has not been achieved. With the use of intravenous methylprednisolone, at a dose of 1 g daily for three days in a total of four cycles, only partial remission with relapses was achieved and control of intraocular pressure was not obtained. Botulinum toxin A was injected for palpebral retraction and exposure keratopathy. Due to the absence of response, systemic treatment with rituximab in two infusions was started, with clinical improvement and control of intraocular pressure. This is the first time it is used in the country in the treatment of thyroid orbitopathy. Rituximab represents a therapeutic alternative in the treatment of thyroid orbitopathy in cases resistant to steroids.