Ragavan Sharanniyan, Elhelw Omar, Majeed Waseem, Kyriacou Angelos, Syed Akheel
Medical School, University of Manchester, Manchester, GBR.
Endocrinology, Salford Royal National Health Service Foundation Trust, Manchester, GBR.
Cureus. 2022 Mar 1;14(3):e22751. doi: 10.7759/cureus.22751. eCollection 2022 Mar.
Alemtuzumab, a humanized monoclonal antibody used as a disease-modifying treatment in relapsing-remitting multiple sclerosis (RRMS), frequently causes autoimmunity as its principal adverse effect. We describe a typical case of a young man treated with two courses of alemtuzumab presenting 18 months later with initial hyperthyroidism due to Graves' disease (GD) followed by persistent hypothyroidism. We discuss the pathophysiological role of stimulating and blocking thyrotropin receptor antibodies in the development of alemtuzumab-induced autoimmune thyroid dysfunction and clinical challenges posed by spontaneous, bidirectional switching between hyperthyroidism and hypothyroidism. Guidelines recommend monitoring thyroid function pre-treatment and every three months for four years following alemtuzumab treatment. Patient education is crucial for maintaining adherence to monitoring programs.
阿仑单抗是一种人源化单克隆抗体，用于复发缓解型多发性硬化症（RRMS）的疾病改善治疗，其主要不良反应常为引发自身免疫。我们描述了一个典型病例，一名年轻男性接受了两个疗程的阿仑单抗治疗，18个月后出现因格雷夫斯病（GD）导致的初始甲状腺功能亢进，随后出现持续性甲状腺功能减退。我们讨论了刺激性和阻断性促甲状腺素受体抗体在阿仑单抗诱导的自身免疫性甲状腺功能障碍发展中的病理生理作用，以及甲状腺功能亢进和甲状腺功能减退之间自发双向转换所带来的临床挑战。指南建议在治疗前及阿仑单抗治疗后的四年内每三个月监测一次甲状腺功能。患者教育对于维持对监测计划的依从性至关重要。
