Clinical efficacy of combined rituximab treatment in a woman with severe Graves' ophthalmopathy

Liu,Xiaomei; Guo,Hui; Liu,Juan; Shi,Bingyin

doi:10.3892/etm.2016.3367

Clinical efficacy of combined rituximab treatment in a woman with severe Graves' ophthalmopathy

Authors:
- Xiaomei Liu
- Hui Guo
- Juan Liu
- Bingyin Shi
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Affiliations: Department of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
Published online on: May 19, 2016 https://doi.org/10.3892/etm.2016.3367
Pages: 1093-1096

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Abstract

The present study reports the case of a female Chinese patient with Graves' disease (GD) and severe Graves' ophthalmopathy (GO) in its active phase, who was treated with propylthiouracil and oral prednisolone for 2 months at a local hospital. However, a lack of improvement in symptoms meant that the patient was transferred to the First Affiliated Hospital of Xi'an Jiaotong University (Xi'an, China), whereupon the patient received high‑dose intravenous methylprednisolone pulse therapy, although with limited efficacy. Subsequently, rituximab (RTX; anti‑CD20 monoclonal antibody) combined with orbital irradiation treatment was initiated. The patient responded positively to the combined treatment; the clinical symptoms and enlargement of the extraocular muscles were ameliorated, and there were marked decreases in the clinical activity and NOSPECS grading scores. Furthermore, the serum levels of anti‑thyrotropin receptor antibodies (TRAb) were markedly decreased at 2 months following RTX therapy. The patient was maintained in a euthyroid state by treatment with methimazole during and following RTX therapy. It was concluded that RTX treatment may attenuate severe GO by depleting lymphocytes, and may promote the recovery of GD by reducing the serum levels of TRAb.

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