Effectiveness and safety of tocilizumab in 2 cases of severe corticosteroid-refractory thyroid orbitopathy. Hospital San José, Bogotá
PDF (Español (España))
HTML (Español (España))


Graves Ophthalmopathy
Graves’ Disease

How to Cite

Sierra Osorio, A., Manosalva Holguín, S., Coy, A., Benavides, J., & Vargas, J. (2021). Effectiveness and safety of tocilizumab in 2 cases of severe corticosteroid-refractory thyroid orbitopathy. Hospital San José, Bogotá. Revista Endocrino, 7(4), 280–284. https://doi.org/10.53853/encr.7.4.655


Thyroid orbitopathy is the most frequent extrathyroid manifestation of autoimmune hyperthyroidism; more than 90% of cases are associated with Graves’ disease. It is a complex disorder that can cause orbital deformity, double vision and even permanent visual loss, with an impact on the quality of life. Approximately, 2% of patients who develop Graves orbitopathy will develop moderate to severe disease. There is growing awareness of the need for early diagnosis and timely management to reduce irreversible sequelae. Its initial management is glucocorticoids; however, recurrence occurs frequently once they are stopped. In more than 60% of cases, normal orbital anatomy is not restored and rehabilitation surgery is required. In cases of refractoriness, biological therapies are an alternative, which have proven its effectiveness. Among these we have teprotumumab, recently approved by the Food and Drug Administration (FDA), which reduces proptosis; rituximab, that reduces inflammation; and tocilizumab, which potentially benefits both parameters. We describe the effect of tocilizumab in two patients with thyroid orbitopathy at the Hospital San José, in Bogotá.

PDF (Español (España))
HTML (Español (España))


Kim JW, Han SH, Son BJ, Rim TH, Keum KC, Yoon JS. Efficacy of combined orbital radiation and systemic steroids in the management of Graves’ orbitopathy. Graefes Arch Clin Exp Ophthalmol. 2016;254(5):991-8.

Coy Villamil H. Orbitopati?a tiroidea: conceptos ba?sicos y diagno?stico cli?nico. Revista Colombiana de Endocrinologi?a, Diabetes y Metabolismo. 2019;6(Supl 1):26-8.

Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(3):456-520.

Taylor PN, Zhang L, Lee RWJ, Muller I, Ezra DG, Dayan CM, et al. New insights into the pathogenesis and nonsurgical management of Graves orbitopathy. Nat Rev Endocrinol. 2020;16(2):104-116.

Marcocci C, Bartalena L, Tanda ML, Manetti L, Dell’Unto E, Rocchi R, et al. Comparison of the effectiveness and tolerability of intravenous or oral glucocorticoids associated with orbital radiotherapy in the management of severe Graves’ ophthalmopathy: results of a prospective, single-blind, randomized study. J Clin Endocrinol Metab. 2001;86(8):3562-7.

Kahaly GJ, Pitz S, Hommel G, Dittmar M. Randomized, single blind trial of intravenous versus oral steroid monotherapy in Graves’ orbitopathy. J Clin Endocrinol Metab. 2005;90(9):5234-40.

Salvi M, Campi I. Medical Treatment of Graves’ Orbitopathy. Horm Metab Res. 2015;47(10):779-88.

Kahaly G, Schrezenmeir J, Krause U, Schweikert B, Meuer S, Muller W, et al. Ciclosporin and prednisone v. prednisone in treatment of Graves’ ophthalmopathy: a controlled, randomized and prospective study. Eur J Clin Invest. 1986;16(5):415-22.

van Geest RJ, Sasim IV, Koppeschaar HP, Kalmann R, Stravers SN, Bijlsma WR, et al. Methylprednisolone pulse therapy for patients with moderately severe Graves’ orbitopathy: a prospective, randomized, placebo-controlled study. Eur J Endocrinol. 2008;158(2):229-37.

Aktaran S, Akarsu E, Erba?ci I, Araz M, Okumu? S, Kartal M. Comparison of intravenous methylprednisolone therapy vs. oral methylprednisolone therapy in patients with Graves’ ophthalmopathy. Int J Clin Pract. 2007;61(1):45-51.

Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, et al. The 2016 European Thyroid Association/European Group on Graves’ Orbitopathy Guidelines for the Management of Graves’ Orbitopathy. Eur Thyroid J. 2016;5(1):9-26.

Macchia PE, Bagattini M, Lupoli G, Vitale M, Vitale G, Fenzi G. High-dose intravenous corticosteroid therapy for Graves’ ophthalmopathy. J Endocrinol Invest. 2001;24(3):152-8.

Pérez-Moreiras JV, Gomez-Reino JJ, Maneiro JR, Perez-Pampin E, Romo Lopez A, Rodríguez Alvarez FM, et al. Efficacy of Tocilizumab in Patients With Moderate-to-Severe Corticosteroid-Resistant Graves Orbitopathy: A Randomized Clinical Trial. Am J Ophthalmol. 2018;195:181-190.

Go?mez C, Imitola A. Orbitopati?a tiroidea: protocolo de manejo basado en revisio?n de la evidencia. Revista Colombiana de Endocrinologi?a, Diabetes y Metabolismo. 2019;6(3):210-7.

Vilar-González S, Lamas-Oliveira C, Fagúndez-Vargas MA, Núñez-Quintanilla AT, Pérez-Rozos A, Merayo-Lloves J, Escobar-Barranco JJ, Rico-Pérez JM. Orbitopatía tiroidea, una visión global con atención especial al papel de la radioterapia. Endocrinol Nutr. 2015;62(4):188-99.

Kumar S, Bahn RS. Relative overexpression of macrophage-derived cytokines in orbital adipose tissue from patients with graves’ ophthalmopathy. J Clin Endocrinol Metab. 2003;88(9):4246-50.

Rubio Álvaro N, Tejedor Prado P, Hidalgo Correas FJ, García Díaz B. Grave prolongación del intervalo QT por venlafaxina. Farm Hosp. 2014;38(5):445-6.

Pérez-Moreiras JV, Alvarez-López A, Gómez EC. Treatment of active corticosteroid-resistant graves’ orbitopathy. Ophthalmic Plast Reconstr Surg. 2014;30(2):162-7.

Atienza-Mateo B, Calvo-Río V, Martín-Varillas JL, Demetrio-Pablo R, Valls-Pascual E, Valls-Espinosa B, et al. SAT0601 Anti-il6-receptor tocilizumab in graves’ orbitopathy. Multicenter study of 46 patients. Ann Rheumatic Dis. 2018;77:1153-4.

Smith TJ, Kahaly GJ, Ezra DG, Fleming JC, Dailey RA, Tang RA, et al. Teprotumumab for Thyroid-Associated Ophthalmopathy. N Engl J Med. 2017;376(18):1748-1761.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.


Download data is not yet available.