Received date: April 10, 2017; Accepted date: April 11, 2017; Published date: April 18, 2017
Citation: Littlefield L, et al (2017) Severe Graves Orbitopathy (GO). Rheumatology (Sunnyvale) 7:i004. doi: 10.4172/2161-1149.1000i004
Copyright: © 2017 Littlefield L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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A 43 year old Filipino male with rapid onset severe visual decline had no light perception, significant bilateral proptosis and exposure keratopathy. Laboratory tests revealed a TSH of 0.9 mclU/mL, T4 0.59 ng/dL, and a TSI 368% of baseline. His hepatitis BsAg and Quantiferon Gold for TB were both positive and treated. A computerized tomography revealed prominence of bilateral extraocular muscles consistent with GO; biopsy revealed fibroadipose tissue and no infection. A diagnosis of GO was made and he failed multiple tarsorrhaphies and high dose corticosteroids. Although the precise etiology of GO is unknown, the role of T and B lymphocytes is well established. Interleukin 6 (IL6) is present in high concentration in patients with Graves’s disease . Two orbital decompressions and Tocilizumab (IL6 receptor inhibitor) improved his sight. He can now perceive light at 1 foot of distance with the left eye, and the right eye continues with complete visual loss (Figure 1).