Longitudinal Glycemic Outcomes in Patients With Thyroid Eye Disease Treated With Teprotumumab

This study analyzed the long-term glycemic trends in thyroid eye disease patients treated with teprotumumab.

A retrospective study was performed at a single institution, including thyroid eye disease patients who started treatment with teprotumumab and had pre- and posttreatment hemoglobin A1c (HbA1c) measurements. Patients were categorized as normoglycemic, prediabetic, or diabetic at baseline. Outcomes included changes in HbA1c from baseline to peak and immediately posttreatment, worsening glycemic control (progression to a higher glycemic category or HbA1c increase ≥0.5%), and recovery to baseline glycemic status.

Seventy-one patients were included: 41 (57.7%) normoglycemic, 20 (28.2%) prediabetic, and 10 (14.1%) diabetic (median follow-up 28 months, interquartile range: 18.5-36.0). Median HbA1c increased most in those with diabetes (+1.4%, peak at 4.8 months), followed by prediabetes (+0.5%, peak at 7.7 months) and normoglycemia (+0.3%, peak at 13.2 months). Worsening glycemic control occurred in 90.0% of diabetic, 50.0% of prediabetic, and 44.0% of normoglycemic patients. Initiation or escalation of medical treatment was required by 60.0% of diabetic, 30.0% of prediabetic, and 2.4% of normoglycemic patients. Among patients with worsening glycemic control, those with diabetes had the lowest rate of recovery to baseline (33.3%), relative to prediabetes (75.0%) and normoglycemia (35.3%).

Teprotumumab may be associated with worsening of glycemic control, with the most pronounced and persistent effects in patients with preexisting glycemic disturbances. The varied timing of peak HbA1c and ongoing need for medical treatment highlight the importance of systematic glycemic risk assessment and routine HbA1c monitoring throughout and after treatment to guide clinical management.