Audiometric changes during teprotumumab therapy for thyroid eye disease: a prospective pilot study

Area of Science:

• Ophthalmology
• Audiology
• Pharmacology

Background:

• Thyroid eye disease (TED) is an autoimmune condition affecting the orbits.
• Teprotumumab is a biologic treatment for moderate to severe TED.
• Potential ototoxicity of teprotumumab requires further investigation.

Purpose of the Study:

• To prospectively evaluate audiologic outcomes in patients with TED treated with teprotumumab.
• To assess longitudinal changes in hearing sensitivity and cochlear function during teprotumumab therapy.
• To investigate the relationship between teprotumumab treatment and hearing alterations.

Main Methods:

• Adult patients receiving teprotumumab underwent audiologic evaluations (pure-tone audiometry, DPOAEs) pre-, during-, and post-treatment.
• Longitudinal changes were analyzed using mixed-effects models.
• Secondary analyses controlled for baseline hearing loss.

Main Results:

• Sixteen participants completed the study.
• Significant hearing threshold elevations were observed in 6 of 9 audiometric frequencies, peaking during active therapy.
• Distortion product otoacoustic emissions (DPOAEs) showed fewer consistent changes compared to audiometry.

Conclusions:

• Teprotumumab therapy is associated with sensorineural hearing decline, indicated by audiometry.
• The observed hearing loss is incompletely captured by DPOAEs, suggesting potential injury to inner hair cells or neural elements.
• Audiometric monitoring during teprotumumab treatment is warranted, alongside research into its ototoxic mechanisms.