The use of tocilizumab in severe glucocorticoid-resistant endocrine ophthalmopathy with optic neuropathy in clinical practice

Thyroid eye disease (TED) is an autoimmune pathology of the orbital tissues associated with autoimmune thyroid disease, most commonly occurring with Graves' disease. The clinical presentation of TED is extremely diverse, ranging from mild orbital involvement to potentially vision-threatening optical neuropathy. Early diagnosis of the active phase of TED is crucial, as immunosuppressive therapy is effective only during this phase, while treatment for patients in the inactive phase consists only of rehabilitative surgery. High-dose intravenous glucocorticoids are the first-line treatment for patients with moderate to severe active TED. Glucocorticoids are widely used due to their anti-inflammatory and immunosuppressive properties, but about 20-30% of patients remain resistant to glucocorticoid treatment. One promising direction in the treatment of glucocorticoid-resistant TED is the use of monoclonal antibodies targeting specific antigen epitopes. We present a clinical case of tocilizumab treatment in severe glucocorticoid-resistant TED complicated by optic neuropathy.