Hammerstad Sara Salehi, Celius Elisabeth G, Husby Henrik, Sørensen Ingvild M, Norheim Ingrid E
Division of Peadiatric and Adolescent Medicine, Oslo University Hospital, Ullevål, Oslo, Norway.
Specialist Center Pilestredet Park, OsloNorway.
J Endocr Soc. 2021 Mar 17;5(6):bvab044. doi: 10.1210/jendso/bvab044. eCollection 2021 Jun 1.
Alemtuzumab (ALZ), a CD52 monoclonal antibody, is highly efficacious in multiple sclerosis; however, side effects are common. Autoimmune thyroid disease (Graves' disease and Hashimoto thyroiditis) is a well-known complication of ALZ. Treatment of ALZ-induced Graves' disease can be challenging, and even more difficult during pregnancy.
We present a case of severe ALZ-induced Graves' disease with a rapid increase in thyrotropin receptor antibodies (TRAb 240 IU/L) and thyrotoxicosis in early pregnancy. Treatment with high doses of antithyroid medication was needed. There was high risk of both fetal and neonatal thyrotoxicosis. Serial fetal sonography showed normal development. The newborn baby presented high levels of TRAb (240 IU/L) and developed neonatal thyrotoxicosis on day 8. Adequate monitoring, treatment, and follow-up of the newborn baby ensured normal thyroid function until disappearance of TRAb 6 weeks after birth.
Multiple sclerosis patients treated with ALZ may develop severe Graves' disease with an increased risk of both fetal and neonatal thyrotoxicosis. Close follow-up with a multidisciplinary approach is needed to ensure a healthy outcome.
阿仑单抗（ALZ）是一种CD52单克隆抗体，在多发性硬化症中疗效显著；然而，副作用很常见。自身免疫性甲状腺疾病（格雷夫斯病和桥本甲状腺炎）是ALZ众所周知的并发症。治疗ALZ诱导的格雷夫斯病具有挑战性，在怀孕期间甚至更困难。
我们报告一例严重的ALZ诱导的格雷夫斯病病例，在妊娠早期促甲状腺素受体抗体（TRAb 240 IU/L）迅速升高并出现甲状腺毒症。需要使用高剂量抗甲状腺药物进行治疗。胎儿和新生儿甲状腺毒症的风险都很高。系列胎儿超声检查显示发育正常。新生儿出生时TRAb水平较高（240 IU/L），并在出生第8天出现新生儿甲状腺毒症。对新生儿进行充分的监测、治疗和随访，确保其甲状腺功能正常，直至出生6周后TRAb消失。
接受ALZ治疗的多发性硬化症患者可能会发生严重的格雷夫斯病，胎儿和新生儿甲状腺毒症的风险增加。需要采用多学科方法进行密切随访，以确保获得健康的结果。
