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Medication-associated thyroid eye disease: a review.

Terence Ang1,2, Abdullah Almater3,4,5, Dinesh Selva6,3

  • 1Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, SA, Australia. terencewxang@gmail.com.

Graefe'S Archive for Clinical and Experimental Ophthalmology = Albrecht Von Graefes Archiv Fur Klinische Und Experimentelle Ophthalmologie
|January 17, 2026
PubMed
Summary

Medications like alemtuzumab and immune checkpoint inhibitors (ICIs) can cause thyroid eye disease (TED). While often similar to standard TED, some ICIs may cause TED-like symptoms without thyroid dysfunction.

Keywords:
AlemtuzumabGraves diseaseImmune checkpoint inhibitorsLenalidomideThyroid dysfunctionThyroid eye diseaseThyroid-associated orbitopathy

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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.