Endocrine Abstracts

A male patient, currently 64 years old, was diagnosed with TED (Thyroid Eye Disease) in 1993 when he underwent surgery for “exophthalmos” in both eyes (likely decompression surgery), followed by surgery to correct diplopia. He underwent a total thyroidectomy one year later. For ongoing “activity” of thyroid and TED patient received radioiodine ablation in 1995 and 1997. At that time, he also received “some pulses” of methylprednisolone and long-term per oral prednisone treatment. He also reported treatment with cyclophosphamide – however, we could not confirm it. For the first time, he was seen at our University clinic in 2016 for five years of ongoing problems with lids edema, eye tiredness, occasional ptosis of the upper eyelid, tearing, and redness, without diplopia. Due to the unusual course of TED, we excluded myasthenia gravis and IgG4-related disease. For recurrent progressions of TED since 2016, he had received at our clinic pulses of methylprednisolone with a cumulative dose of 7,5g, three times 100 mg Rituximab, prolonged per oral therapy with prednisone and one-year treatment of cyclosporine. While on cyclosporine, he developed exposure keratopathy, which required tarsorrhaphy. In October 2022, he was switched to Tocilizumab 162 mg s.c. weekly and we have started to see dramatic changes in his appearance (decreased swelling, decreased redness, and improved eye motility). His TSI (Thyroid Stimulating Immunoglobulin), which was till Tocilizumab (at least since 2016), all the time above the detection threshold (>40 mlU/l) started to decrease. This work was supported by the Ministry of Health of the Czech Republic - Conceptual development of research organization (FNOL, 00098892) and grant no. NU21J-01-00017. All rights are reserved.