{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:44:12Z","timestamp":1790628252109,"version":"4.1.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Tocilizumab (TCZ) has been demonstrated to be effective in treating thyroid-associated ophthalmopathy (TAO); however, its efficacy in hormone-resistant dysthyroid optic neuropathy (DON) remains unclear. This study aims to identify baseline and post-treatment indicators that can predict the necessity for surgical intervention following TCZ therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty-one hormone-resistant DON patients treated with TCZ were categorized into surgery (n=15, 7 males, 8 females) and non-surgery (n=16, 8 males, 8 females) groups based on their post-TCZ surgical status. Retrospective comparisons between the two groups were performed using pre- and post-treatment ophthalmic assessments, biomarkers, and orbital magnetic resonance imaging (MRI) scans. The predictive value of identified variables was evaluated through receiver operating characteristic (ROC) curve analysis and logistic regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The surgery group exhibited a significantly higher baseline thyroid-stimulating hormone receptor antibody (TRAb) (<jats:italic>P<\/jats:italic>=0.001) and a positive change in the maximal signal intensity ratio of extraocular muscle to temporalis muscle (SIR(EOM\/temporalis)<jats:sub>MAX<\/jats:sub>), whereas the non-surgery group demonstrated a negative change (<jats:italic>P<\/jats:italic>&amp;lt;0.001). A TRAb cut-off value of \u22645.07 IU\/L predicted non-surgery with 93.3% sensitivity and 81.2% specificity, while a SIR(EOM\/temporalis)<jats:sub>MAX<\/jats:sub> cut-off value of \u2264-1.83 had 86.7% sensitivity and 87.5% specificity. The area under the curve was 0.846 for TRAb and 0.863 for SIR(EOM\/temporalis)<jats:sub>MAX<\/jats:sub>. Multivariate regression confirmed SIR(EOM\/temporalis)<jats:sub>MAX<\/jats:sub> change (<jats:italic>P<\/jats:italic>=0.017) as an independent predictor of surgical intervention. Linear regression revealed a significant correlation between SIR(EOM\/temporalis)<jats:sub>MAX<\/jats:sub> change and TCZ dosage in the non-surgery group (<jats:italic>P<\/jats:italic>=0.005), but not in the surgery group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The percentage change in SIR(EOM\/temporalis)<jats:sub>MAX<\/jats:sub> following TCZ treatment and baseline TRAb can serve as predictors of the necessity for surgical intervention in hormone-resistant DON. These indicators assist in the personalization of TCZ therapy and in the avoidance of unnecessary surgical procedures.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fimmu.2025.1556742","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T05:25:51Z","timestamp":1748496351000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Key indicators for guiding tocilizumab therapy to prevent orbital decompression surgery in hormone-resistant dysthyroid optic 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