Rituximab Treatment of Graves' Dysthyroid Ophthalmopathy

Inclusion Criteria: * Patients eighteen years of age or older.Diagnosed with Graves' dysthyroid ophthalmopathy within one year of presentation. * Manifest significant ophthalmic findings of active Graves' disease. (Clinical activity score 4 or greater) * Evidence of thyroid abnormality (hyper or hypo thyroid) prior to thyroid treatment * Elevated thyroid stimulating immunoglobulin, antithyroid peroxidase antibody or antithyroglobulin antibody. Exclusion Criteria: Long standing chronic disease. (greater than one year) History of ineffective prior orbital irradiation. Clinical activity score of less than 4. * ANC \< 1.5 x 103 * Hemoglobin: \< 8.5 gm/dL * Platelets: \< 100,000/mm * AST or ALT \>2.5 x Upper Limit of Normal unless related to primary disease. * IgG: \< 5.6 mg/dl and IgM: \< .55 mg/dl * Positive Hepatitis B or C serology (Hep B Surface antigen and Hep C antibody) * History of positive HIV (HIV conducted during screening if applicable) * Treatment with any investigational agent within 4 weeks of screening or 5 half-lives of the investigational drug (whichever is longer) * Receipt of a live vaccine within 4 weeks prior to randomization * Previous Treatment with Rituximab (MabThera® / Rituxan®) * History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibodies * History of recurrent significant infection or history of recurrent bacterial infections * Known active bacterial, viral fungal mycobacterial, or other infection (including tuberculosis or atypical, mycobacterial disease, but excluding fungal infections of nail beds) or any major episode of infection requiring hospitalization or treatment with i.v. antibiotics within 4 weeks of screening or oral antibiotics within 2 weeks prior to screening * Lack of peripheral venous access * History of drug, alcohol, or chemical abuse within 6 months prior to screening * Pregnancy (a negative serum pregnancy test should be performed for all women of childbearing potential within 7 days of treatment) or lactation * Concomitant malignancies or previous malignancies, with the exception of adequately treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix * History of psychiatric disorder that would interfere with normal participation in this protocol * Significant cardiac, including significant or uncontrolled arrhythmia, or pulmonary disease (including obstructive pulmonary disease) * History of systemic lupus erythematosis * Any other disease, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the patient at high risk from treatment complications. Inability to comply with study and follow-up procedures \-