MON-428 - Extended Teprotumumab Beyond Standard Protocol for Refractory Thyroid Eye Disease

Background
In patients with Thyroid Eye Disease (TED), intravenous glucocorticoids, or an 8-infusion protocol of Teprotumumab are viable treatments; however, when first-line therapy is inadequate, a prolonged course beyond the standard 8 infusions of Teprotumumab can be explored.
CASE REPORT
A 72-year-old woman with a history of Graves’ disease and TED status post total thyroidectomy and Teprotumumab with 8 infusions every 3 weeks over 6 months did not have improvement in her TED symptoms. During her initial infusion she also experienced fatigue and brittle nails. She returned to medical care 3 years later with symptoms that have been stable since her initial infusion protocol that included ocular itching and burning sensation bilaterally, spontaneous L retrobulbar pain, diplopia with extreme ocular movement, chemosis, proptosis, and conjunctivitis with an initial clinical activity score (CAS) of 5/7. Given her refractory TED, a 2nd 8-infusion protocol was started leading to a sustained improvement of her symptoms and a reduced CAS of 1/10 without side effects after being followed up for 3 months after treatment ended.
Discussion/Conclusion
Our case highlights an alternative therapy for TED refractory to the 8-infusion Teprotumumab protocol which includes a 2nd 8-infusion Teprotumumab course when the standard treatment did not adequately alleviate TED symptoms initially. This case report adds to the growing literature on treatment of refractory TED. Further studies are needed.

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