Alemtuzumab Induced Thyroid Eye Disease – A Comprehensive Case Series and Review of the Literature

Abstract

Purpose : To present five cases of Alemtuzumab-Induced Thyroid Eye Disease (AI-TED) and review the literature to highlight the natural history, severity, and outcomes as compared to conventional thyroid eye disease (TED).

Methods : A multi-institutional retrospective case series of patients with AI-TED was compiled. Chart review evaluated for clinical characteristics, imaging findings, and treatment for AI-TED. Additionally, a comprehensive review of the literature identified all previously published cases of AI-TED.

Results : Five new patients with AI-TED were included in this series. The average clinical activity score on presentation was 2.8 (range 1-4) and reached an average peak of 5.0 during the active phase of the disease (4 – 7). Patients were treated medically with selenium (40%) or monoclonal antibodies including teprotumumab or tocilizumab (40%). Surgical treatment with orbital decompression for compressive optic neuropathy was performed on 2 (40%) patients. Combined with 11 previously reported cases, these 16 patients with AI-TED had an average CAS on presentation of 3.3. The average length of the AI-TED phase was 14.0 months, and all patients were treated with medical and/or surgical interventions for their disease.

Conclusions : Clinical and imaging findings in AI-TED mirror that of conventional TED, however AI-TED may present with greater severity. AI-TED may develop many months after Graves’ Disease; therefore, providers should be aware of this association and monitor patients for the development of severe TED.

This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.