Teprotumumab for Treatment of Pretibial Myxedema

Abstract

Pretibial myxedema (PTM), also called thyroid dermopathy, is a dreaded and potentially debilitating manifestation of thyroid disease, more commonly Graves' disease, which can occur at any time over the course of the disease. No substantial long-term therapies have been able to target the condition, and management has typically been supportive (eg, compression socks, weight loss), with courses of moderate-intensity steroids. Teprotumumab has been approved for the management of thyroid eye disease (TED), and it is believed that the 2 share a similar pathophysiology likely related to type 1 insulin-like growth factor receptor, which may explain why some patients have also experienced improvement in PTM. Here we present a patient who received 8 doses of teprotumumab for TED who, over the course of management and into follow-up, experienced significant improvement in her pretibial myxedema. The patient noted considerable improvement in quality of life and ability to perform daily activities. We present this case to consider further investigation into the utilization of teprotumumab for thyroid disease-related PTM in patients with impaired quality of life.

Keywords: pretibial myxedema; teprotumumab; thyroid eye disease.

Figure 1.

A, right foot, and B, left foot, Patient's initial photos before teprotumumab therapy. Taken in office, July 12, 2021, by Rajinderpal Chahal, MD.

Figure 2.

A, right foot, and B, left foot, Patient's photos during her teprotumumab course. Taken in office, January 17, 2022, by Rajinderpal Chahal, MD.

Figure 3.

A, right foot, and B, left foot, Patient photos after completion of her teprotumumab course. Taken in office, March 17, 2022, by Rajinderpal Chahal, MD.