Thyroid Eye Disease-Like Conditions Associated With Cancer and Immune Check Point Blockage: Systematic Literature...

Area of Science:

• Ophthalmology
• Oncology
• Immunology

Background:

• Thyroid eye disease-like (TED-like) orbitopathy is an uncommon condition.
• Its occurrence in paraneoplastic syndromes or with immune checkpoint inhibitors (ICIs) is increasingly recognized.

Purpose of the Study:

• To systematically review literature on TED-like orbitopathy associated with paraneoplastic syndromes or ICIs.
• To report a case of paraneoplastic TED-like orbitopathy.

Main Methods:

• Comprehensive literature search of PubMed, Embase, and Scopus databases.
• Inclusion of full-text articles, with data extraction on patient demographics, oncologic diagnosis, ICI exposure, and clinical/imaging features.

Main Results:

• 21 patients developed TED-like orbitopathy after ICI therapy (anti-CTLA-4 or anti-PD-1/PD-L1).
• 18 paraneoplastic cases mimicking TED were identified, associated with seminomas, lymphomas, and lung carcinomas.
• Clinical and imaging findings resembled classic TED, but thyroid autoimmunity was absent.

Conclusions:

• TED-like orbitopathy is a rare but growing oncologic manifestation.
• It can arise as a paraneoplastic phenomenon or an ICI-related adverse event.
• The absence of thyroid autoimmunity suggests alternative immune mechanisms, possibly involving cytotoxic T lymphocytes.