Niedzialkowska Ewelina, Pokharel Ashbita, Banka Ajaz
Department of Internal Medicine, Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
Department of Pathology, Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA.
BMJ Case Rep. 2024 Dec 22;17(12):e260129. doi: 10.1136/bcr-2024-260129.
Thyroid dermopathy (TD) and thyroid eye disease (TED) are rare clinical entities in patients with hypofunctional autoimmune thyroid disease; however, these can be present in patients with thyroid-stimulating immunoglobulin (TSI)/anti-thyroid-stimulating hormone receptor (TSHR) antibodies. TED is believed to be associated with antibodies stimulating TSHRs and cross-talk with IGF-1 receptor (IGF-1R) pathway, prompting tissue proliferation. Teprotumumab (monoclonal antibody targeting IGF-1R) has been proven to improve symptoms of TED. It is proposed that TD share the same pathophysiology as TED. We present a case of a patient with hypofunctional autoimmune thyroid disease with high TSI/anti-TSHR antibodies who experienced significant improvement of symptoms of both TED and TD after six doses of teprotumumab. We postulate that further studies regarding the efficacy of teprotumumab in patients with TD are needed.
甲状腺皮肤病（TD）和甲状腺眼病（TED）在功能减退的自身免疫性甲状腺疾病患者中是罕见的临床病症；然而，甲状腺刺激免疫球蛋白（TSI）/抗甲状腺刺激激素受体（TSHR）抗体阳性的患者也可能出现这些病症。TED被认为与刺激TSHR的抗体以及与胰岛素样生长因子-1受体（IGF-1R）途径的相互作用有关，从而促使组织增生。替普罗单抗（靶向IGF-1R的单克隆抗体）已被证明可改善TED的症状。有人提出TD与TED具有相同的病理生理学。我们报告一例功能减退的自身免疫性甲状腺疾病患者，其TSI/抗TSHR抗体水平较高，在接受六剂替普罗单抗治疗后，TED和TD的症状均有显著改善。我们推测需要进一步研究替普罗单抗对TD患者的疗效。
