Medication-associated thyroid eye disease: a review

Area of Science:

• Endocrinology
• Ophthalmology
• Immunology

Background:

• Thyroid eye disease (TED) is an autoimmune condition affecting the orbits.
• Medication-induced thyroid dysfunction is a known complication of certain drugs.
• The link between specific medications and the development of TED requires systematic review.

Purpose of the Study:

• To systematically review the literature on medication-associated thyroid eye disease (TED).
• To identify medications implicated in the development of TED.
• To compare the characteristics of medication-associated TED with de novo TED.

Main Methods:

• Systematic literature search of PubMed, EMBASE, and Web of Science up to March 31, 2025.
• Inclusion of studies describing medication-associated thyroid dysfunction and subsequent TED development.
• Exclusion of articles lacking thyroid dysfunction or orbitopathy.

Main Results:

• Twenty-three studies met inclusion criteria, implicating alemtuzumab, immune checkpoint inhibitors (ICIs), amiodarone, and lenalidomide.
• Alemtuzumab-associated TED showed a mean onset of thyroid dysfunction at 26.3 months and TED at 19.9 months post-dysfunction.
• Immune checkpoint inhibitors (ICIs), particularly anti-CTLA-4 drugs like ipilimumab and tremelimumab, were frequently implicated, sometimes causing orbitopathy without thyroid dysfunction.

Conclusions:

• Medication-associated TED is a crucial differential diagnosis for orbital inflammatory conditions.
• Clinical and radiological features, along with management, are generally similar to de novo TED.
• Certain ICIs can present unique orbital inflammation phenotypes, including TED or "TED-like" orbitopathy independent of thyroid dysfunction.