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Recalcitrant thyroid eye disease responsive to targeted EGFR inhibition in a patient with lung adenocarcinoma: a case
Rachel E Cain1, Alison H Watson2
1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Abstract:
Thyroid eye disease (TED) is an autoimmune disorder targeting periorbital tissue with potentially devastating effects. Treatment options for TED are limited and have side effects that prohibit their use in certain patients. As such, there is increasing interest to identify new therapeutic targets. We report a case of long standing and refractory thyroid eye disease that was responsive to targeted epidermal growth factor receptor (EGFR) inhibition with osimertinib. The patient presents with Graves disease and thyroid eye disease diagnosed 2 years prior and previously treated with steroids and teprotumumab. Her TED reactivated and was unresponsive to oral steroids. Five months later she was diagnosed with lung adenocarcinoma and began targeted EGFR inhibition with osimertinib. Notably, her TED symptoms rapidly improved. Following the completion of a course of osimertinib, her TED reactivated but again rapidly improved after resuming osimertinib. This case highlights EGFR as a potential novel therapeutic target in TED.
Insights
Thyroid eye disease (TED) can be refractory to standard treatments. This case study shows that targeted epidermal growth factor receptor (EGFR) inhibition with osimertinib may be a promising new therapy for TED.
Area of Science:
- Ophthalmology
- Endocrinology
- Oncology
Background:
- Thyroid eye disease (TED) is an autoimmune condition affecting the tissues around the eyes, often associated with Graves' disease.
- Current TED treatments have limitations and potential side effects, driving the search for novel therapeutic targets.
- Refractory cases of TED pose a significant clinical challenge, necessitating exploration of alternative treatment strategies.
Purpose of the Study:
- To report a case of long-standing, refractory thyroid eye disease that responded to targeted therapy.
- To investigate the potential of epidermal growth factor receptor (EGFR) inhibition as a novel treatment for TED.
Main Methods:
- A patient with a history of Graves' disease and refractory TED was treated with osimertinib, a targeted EGFR inhibitor, for lung adenocarcinoma.
- The patient's TED symptoms were monitored before, during, and after osimertinib treatment.
Main Results:
- The patient experienced rapid improvement in TED symptoms upon initiation of osimertinib therapy.
- TED symptoms recurred after discontinuation of osimertinib but improved again upon re-initiation of the drug.
- This suggests a direct link between EGFR inhibition and TED symptom management.
Conclusions:
- Epidermal growth factor receptor (EGFR) inhibition with osimertinib shows potential as a novel therapeutic approach for refractory thyroid eye disease.
- This case highlights EGFR as a potential therapeutic target for managing TED.
- Further research is warranted to explore the efficacy and safety of EGFR inhibitors in a broader TED patient population.
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