IGF-1R Antagonism in Thyroid Eye Disease and Female Reproductive Function

Area of Science:

• Endocrinology
• Reproductive Biology
• Pharmacology

Background:

• Insulin-like growth factor-1 receptor (IGF-1R) plays a crucial role in female reproductive health.
• Teprotumumab, an IGF-1R antagonist, is used to treat thyroid eye disease.
• Menstrual abnormalities have been anecdotally reported in women using teprotumumab.

Purpose of the Study:

• To review the current understanding of IGF-1R's function in female reproduction.
• To identify mechanisms causing menstrual abnormalities in women treated with teprotumumab.
• To explore the link between IGF-1R antagonism and menstrual dysfunction.

Main Methods:

• Narrative review of existing literature.
• Identification of studies reporting menstrual changes with teprotumumab.
• Exploration of IGF-1R signaling and reproductive physiology literature to form a hypothesis.

Main Results:

• Menstrual abnormalities, primarily amenorrhea, occur in 5%-50% of patients treated with teprotumumab.
• IGF-1R is expressed in key reproductive tissues: hypothalamus, pituitary, ovary, and endometrium.
• These findings suggest a biological basis for teprotumumab-induced menstrual changes.

Conclusions:

• IGF-1R antagonism likely disrupts ovarian folliculogenesis, steroidogenesis, and ovulation.
• Further research is needed to elucidate the precise mechanisms of reproductive disruption.
• Long-term effects and potential lasting detriments of IGF-1R antagonism require investigation.