Beyond the Eyes: Is Teprotumumab Effective for Thyroid Dermopathy?

BACKGROUND: Pretibial dermopathy (PTD) is a rare, disfiguring manifestation of Graves' disease. The shared pathophysiology with thyroid eye disease (TED), centered on fibroblast activation via a thyroid-stimulating hormone receptor and insulin-like growth factor-1 receptor (IGF-1R) complex, provides a strong rationale for using the IGF-1R inhibitor, teprotumumab. METHODS: We present a case series of five patients with severe PTD and concomitant TED who were treated with teprotumumab. A review of reported cases in the literature was also conducted. RESULTS: All patients experienced significant clinical improvement, including regression of skin thickening as well as enhanced functional capacity. Side effects included mild hearing loss, muscle cramps, and fatigue. One patient experienced a severe gastrointestinal event requiring treatment discontinuation, while those experiencing a recurrence of PTD, responded to a second course of therapy. CONCLUSIONS: Teprotumumab showed promising efficacy in the treatment of PTD. Further studies are needed to confirm its durability and safety.