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Hearing loss in hyperthyroid patients treated with teprotumumab (TepezzaR)
Murilo de Santana Hager1, Chloe Cottone2, Paula Valeria Guerra Navarro2
1Jacobs School of Medicine and Biomedical Sciences, the University at Buffalo, 955 Main St, Buffalo, NY, 14203, USA. murilode@buffalo.edu.
Purpose:
To evaluate the association between teprotumumab use and hearing loss in hyperthyroid patients using real-world, population-level data.
Methods:
A retrospective cohort study using the TriNetX Collaborative Network was used to identify patients with hyperthyroidism (ICD-10 code E05) from 2006 to 2024. Two groups were established: one comprised of patients treated with teprotumumab and a control group of patients not treated with teprotumumab. Hearing loss was categorized as sensorineural (ICD-10 H90.A2, H90.A3, H90.A4, H90.A5), mixed (ICD-10 H90.A3, H90.A6, H90.A7, H90.A8), conductive (ICD-10 H90.0, H90.A1, H90.1, H90.2), or unspecified (ICD-10 H91.9). Cases of hearing loss occurring after teprotumumab initiation (in the treated group) or after hyperthyroidism diagnosis (in the control group) were recorded. Relative risk was calculated within a 95% confidence interval. Groups were propensity score matched for age and gender.
Results:
A total of 2,164 patients were included (1,082 per cohort; mean age 55.9 years, SD = 14.6), with 793 (73.3%) female and 258 (23.8%) male in each group. Sensorineural hearing loss occurred in 154 (14.2%) of Teprotumumab users versus 51 (4.7%) of controls (P < .001), corresponding to a relative risk (RR) of 3.15 (95% CI: 2.31-4.27). Unspecified hearing loss was reported in 78 (7.2%) Teprotumumab patients versus 47 (4.3%) controls (P = .006; RR = 1.66; 95% CI: 1.17-2.36). Conductive and mixed hearing loss could not be reliably analyzed due to small sample sizes (N < 10 per group).
Conclusion:
Teprotumumab use is associated with a significantly increased risk of sensorineural and unspecified hearing loss in patients with hyperthyroidism. These findings support routine audiologic monitoring during treatment and highlight the need for prospective studies to investigate underlying mechanisms and preventative strategies.
