Managing active Pediatric Thyroid Eye Disease with Tocilizumab: A Case Study of Therapeutic Benefits and Adverse Events
Author: Maggie K. Pecsok
Base Hospital / Institution: University of Pennsylvania, Perelman School of Medicine
ePoster presentation
Abstract ID: 25-497
Purpose
Tocilizumab, an interleukin-6 inhibitor, can effectively treat active pediatric thyroid eye disease (TED) as an alternative to systemic corticosteroids or surgical decompression. This case illustrates its potential and challenges.
Methods
This is a case report of a pediatric TED patient treated with tocilizumab.
Results
A 13-year-old female with Graves’ disease presented with 2 years of progressive proptosis, exposure keratopathy, intermittent eyelid swelling, and ocular hypertension causing psychosocial distress. Initial exam showed bilateral conjunctival injection, scleral show, lagopthalmos, and proptosis (23.5mm OD, 21.5mm OS). Visual acuity, pupillary response, intraocular pressure, extraocular movement, color vision, alignment, slit lamp, and dilated fundus exam were otherwise normal. Labs showed euthyroidism with elevated TSH receptor antibody and thyroid-stimulating immunoglobulin. CT showed bilateral fat expansion without muscle enlargement. She was not a candidate for steroids (lack of orbital inflammation; psychiatric history), teprotumumab (age), or surgery (active thyroid disease). She began tocilizumab 8 mg/kg every 4 weeks for 8 doses in coordination with rheumatology. Side effects, including facial hives, vomiting, and dizziness, were treated with cetirizine, famotidine, and methylprednisolone premedication for subsequent doses. She also developed chronic urticaria, hypertriglyceridemia and arthralgias that resolved after treatment. Post-treatment, proptosis improved significantly (21.8mm OD, 20 mm OS) and exposure keratopathy and lagophthalmos resolved. She remained stable despite ongoing thyroid disease activity.
Conclusion
Tocilizumab shows promise in pediatric TED, inhibiting IL-6-driven inflammation and potentially lowering TSI levels via reduced orbital fibroblast differentiation. It offers an alternative when corticosteroids are less effective due to minimal orbital inflammation and surgery is unsuitable due to patient age or thyroid disease activity. Close monitoring for infusion reactions, infections, and hepatic injury is essential.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Gabriela M. | Lahaie Luna | Children’s Hospital of Philadelphia |
