Teprotumumab in advanced reactivated thyroid eye disease
Purpose: To report the case of a patient with reactivated, refractory thyroid eye disease (TED) treated with teprotumumab. Observations: A 51-year-old female with a 16-year history of thyroid eye disease previously treated with orbital decompression and multiple eyelid surgeries presented in a recur...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | American Journal of Ophthalmology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2451993622002304 |
| _version_ | 1817980459976491008 |
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| author | Olivia T. Cheng Dianne M. Schlachter |
| author_facet | Olivia T. Cheng Dianne M. Schlachter |
| author_sort | Olivia T. Cheng |
| collection | DOAJ |
| description | Purpose: To report the case of a patient with reactivated, refractory thyroid eye disease (TED) treated with teprotumumab. Observations: A 51-year-old female with a 16-year history of thyroid eye disease previously treated with orbital decompression and multiple eyelid surgeries presented in a recurrent flare of the disease. The disease recurrence was refractory to intravenous steroid therapy and only partially responsive to oral steroid therapy, and the patient developed dysthyroid optic neuropathy in the right eye with decreased visual acuity and color vision. Clinical activity score was 8/10 and proptosis measurements were 27 mm OD and 26 mm OS. The patient underwent treatment with eight infusions of teprotumumab coinciding with a low taper of oral prednisone and experienced resolution of dysthyroid optic neuropathy, decrease of clinical activity score to 1, and dramatic improvement in proptosis (17 mm OD, 17 mm OS) and extraocular muscle size on imaging. Thirty weeks after completion of teprotumumab and 2 weeks after the second dose of the COVID vaccine, she experienced another flare and subsequently underwent bilateral orbital decompressions. Conclusion: This case report suggests teprotumumab may be used in patients with reactivation of longstanding thyroid eye disease. Reduction of extraocular muscle size and improvement in proptosis suggest teprotumumab may be disease-modifying even in advanced cases. |
| first_indexed | 2024-04-13T22:54:02Z |
| format | Article |
| id | doaj.art-80dc241b51754fb8abb3a49f39ea9092 |
| institution | Directory Open Access Journal |
| issn | 2451-9936 |
| language | English |
| last_indexed | 2024-04-13T22:54:02Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Journal of Ophthalmology Case Reports |
| spelling | doaj.art-80dc241b51754fb8abb3a49f39ea90922022-12-22T02:26:05ZengElsevierAmerican Journal of Ophthalmology Case Reports2451-99362022-06-0126101484Teprotumumab in advanced reactivated thyroid eye diseaseOlivia T. Cheng0Dianne M. Schlachter1Beaumont Eye Institute, 3535 West 13 Mile Road #555, Royal Oak, MI, USABeaumont Eye Institute, 3535 West 13 Mile Road #555, Royal Oak, MI, USA; Consultants in Ophthalmic and Facial Plastic Surgery, 29201 Telegraph Road, Suite 324, Southfield, MI, USA; Corresponding author. Consultants in Ophthalmic and Facial Plastic Surgery, 29201 Telegraph Road, Suite 324, Southfield, MI, 48034, USA.Purpose: To report the case of a patient with reactivated, refractory thyroid eye disease (TED) treated with teprotumumab. Observations: A 51-year-old female with a 16-year history of thyroid eye disease previously treated with orbital decompression and multiple eyelid surgeries presented in a recurrent flare of the disease. The disease recurrence was refractory to intravenous steroid therapy and only partially responsive to oral steroid therapy, and the patient developed dysthyroid optic neuropathy in the right eye with decreased visual acuity and color vision. Clinical activity score was 8/10 and proptosis measurements were 27 mm OD and 26 mm OS. The patient underwent treatment with eight infusions of teprotumumab coinciding with a low taper of oral prednisone and experienced resolution of dysthyroid optic neuropathy, decrease of clinical activity score to 1, and dramatic improvement in proptosis (17 mm OD, 17 mm OS) and extraocular muscle size on imaging. Thirty weeks after completion of teprotumumab and 2 weeks after the second dose of the COVID vaccine, she experienced another flare and subsequently underwent bilateral orbital decompressions. Conclusion: This case report suggests teprotumumab may be used in patients with reactivation of longstanding thyroid eye disease. Reduction of extraocular muscle size and improvement in proptosis suggest teprotumumab may be disease-modifying even in advanced cases.http://www.sciencedirect.com/science/article/pii/S2451993622002304Thyroid eye disease (TED)TeprotumumabProptosisClinical activity score (CAS)Disease recurrenceDysthyroid optic neuropathy (DON) |
| spellingShingle | Olivia T. Cheng Dianne M. Schlachter Teprotumumab in advanced reactivated thyroid eye disease American Journal of Ophthalmology Case Reports Thyroid eye disease (TED) Teprotumumab Proptosis Clinical activity score (CAS) Disease recurrence Dysthyroid optic neuropathy (DON) |
| title | Teprotumumab in advanced reactivated thyroid eye disease |
| title_full | Teprotumumab in advanced reactivated thyroid eye disease |
| title_fullStr | Teprotumumab in advanced reactivated thyroid eye disease |
| title_full_unstemmed | Teprotumumab in advanced reactivated thyroid eye disease |
| title_short | Teprotumumab in advanced reactivated thyroid eye disease |
| title_sort | teprotumumab in advanced reactivated thyroid eye disease |
| topic | Thyroid eye disease (TED) Teprotumumab Proptosis Clinical activity score (CAS) Disease recurrence Dysthyroid optic neuropathy (DON) |
| url | http://www.sciencedirect.com/science/article/pii/S2451993622002304 |
| work_keys_str_mv | AT oliviatcheng teprotumumabinadvancedreactivatedthyroideyedisease AT diannemschlachter teprotumumabinadvancedreactivatedthyroideyedisease |