Early experience with teprotumumab for chronic thyroid eye d
Thyroid eye disease (TED) is an autoimmune condition with multiple ophthalmic manifestations and psychosocial consequences.TED has been described to follow Rundle's curve with an active inflammatory phase followed by disease quiescence. It is generally accepted that the active phase is when the course and outcome of TED can be altered by interventions. Previously reported treatment options include various courses of corticosteroid therapy, orbital radiotherapy, and more recently monoclonal antibodies such as rituximab.

A 50-year-old female with a 3-year history of Graves’ disease presented with bilateral exophthalmos greatest on the left side. She was followed for 2 years with stable proptosis measurements (23mm OD, 28mm OS). Her clinical activity score (CAS) was 1 and there were no examination findings reflective of active inflammation. The patient underwent systemic treatment with teprotumumab and despite chronic TED and low CAS, she had a notable improvement in proptosis (18mm OD, 22mm OS) and a decrease in extraocular muscle volume as noted on orbital imaging.

This case report suggests that teprotumumab may be used in patients with chronic TED and low CAS. Improvement in the proptosis and reduction in extraocular muscle volume suggest that teprotumumab may alter disease course even in patients with inactive or quiescent TED.