Gama Catarina, Oliveira Margarida A, Marques Bernardo, Branco Pedro, Duarte Sequeira
Endocrinology, Diabetes, and Metabolism, Unidade Local de Saúde de Lisboa Ocidental, Hospital de Egas Moniz, Lisbon, PRT.
Otolaryngology - Head and Neck Surgery, Unidade Local de Saúde de Lisboa Ocidental, Hospital de Egas Moniz, Lisbon, PRT.
Cureus. 2025 Jul 30;17(7):e89064. doi: 10.7759/cureus.89064. eCollection 2025 Jul.
Dupilumab, a monoclonal antibody targeting interleukin-4 (IL-4) and IL-13, is widely used for the treatment of type 2 inflammatory conditions such as atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis. Although generally well-tolerated, dupilumab has been linked to rare thyroid-related events. We report a case of Graves' disease (GD) in a 47-year-old man with severe nasal polyposis who developed heat intolerance and weight loss within six to eight weeks of starting dupilumab. Laboratory tests confirmed thyrotoxicosis with positive thyroid-stimulating hormone receptor antibodies (TSHR-Ab), leading to a GD diagnosis. The patient was started on methimazole and remains stable on both methimazole and dupilumab. The temporal association between dupilumab initiation and the detection of TSHR-Ab suggests a possible link between dupilumab therapy and the development of GD. This may be mediated by a shift from Type 2 helper T cells (Th2) to Type 1 helper T cells (Th1) immune dominance, which is known to promote autoimmune thyroid activity. Such a mechanism is biologically plausible and consistent with current immunopathogenic models of GD. This case adds to the limited literature on dupilumab-associated autoimmune thyroid disease. Physicians should consider monitoring thyroid function in patients on dupilumab, especially those with immune-mediated conditions. Further studies are needed to clarify this mechanism and guide screening guidelines.
度普利尤单抗是一种靶向白细胞介素-4（IL-4）和IL-13的单克隆抗体，广泛用于治疗2型炎症性疾病，如特应性皮炎、哮喘和伴有鼻息肉的慢性鼻-鼻窦炎。尽管度普利尤单抗总体耐受性良好，但它与罕见的甲状腺相关事件有关。我们报告了一例47岁患有严重鼻息肉的男性格雷夫斯病（GD）病例，该患者在开始使用度普利尤单抗后的6至8周内出现不耐热和体重减轻。实验室检查证实为甲状腺毒症，甲状腺刺激素受体抗体（TSHR-Ab）呈阳性，从而确诊为GD。患者开始服用甲巯咪唑，在甲巯咪唑和度普利尤单抗治疗下病情保持稳定。开始使用度普利尤单抗与检测到TSHR-Ab之间的时间关联表明度普利尤单抗治疗与GD的发生之间可能存在联系。这可能是由2型辅助性T细胞（Th2）向1型辅助性T细胞（Th1）免疫优势的转变介导的，已知这种转变会促进自身免疫性甲状腺活动。这样的机制在生物学上是合理的，并且与当前GD的免疫发病模型一致。该病例增加了关于度普利尤单抗相关自身免疫性甲状腺疾病的有限文献。医生应该考虑对使用度普利尤单抗的患者进行甲状腺功能监测，尤其是那些患有免疫介导疾病的患者。需要进一步研究来阐明这种机制并指导筛查指南。
