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THYROID EYE DISEASE
The risk of developing hyperglycemia during treatment with teprotumumab (Tepezza™)
BACKGROUND
Thyroid eye disease (TED) is an autoimmune condition that includes inflammation of the eyes, eye muscles and the surrounding tissues. Symptoms include dry eyes, red eyes, bulging of the eyes and double vision. This means these patients develop antibodies that get confused and attack the body’s own cells. In the case of TED, this means antibodies that attack the muscles around the eye. TED most often occurs in the setting of Graves’ disease, the most common cause of hyperthyroidism. It also can be seen with Hashimotos thyroiditis, the most common cause of autoimmune hypothyroidism. Teprotumumab (Tepezza™) is a relatively new treatment for the management of TED that has shown excellent responses.
Most patients treated with teprotumumab tolerate the treatment with few side effects. However, hyperglycemia (high blood sugar) has emerged as a significant adverse event, occurring in up to 10% of patients. This study aimed to definitively characterize the risk of hyperglycemia associated with teprotumumab by using a global electronic health records database, thereby providing a more generalizable estimate of this adverse effect in clinical practice.
THE FULL ARTICLE TITLE
Lishinsky-Fischer N et al. Teprotumumab-associated hyperglycemia: a large-scale multinational cohort study. Thyroid. Epub 2026 Apr 9:10507256261442501. doi: 10.1177/10507256261442501. PMID: 41954033.
SUMMARY OF THE STUDY
The investigators identified TED patients who received at least four infusions of teprotumumab using the TriNetX Global Collaborative Network, encompassing over 165 health care organizations worldwide. Matching accounted for demographics, other illness affecting glucose levels, baseline A1C, BMI, and treatment with steroids exposure. The primary outcomes were the 5-year cumulative incidence of prediabetes, diabetes, severe hyperglycemia, and initiation of antidiabetes medications.
Overall, 792 patients were included in the teprotumumab- treated group and 792 patients were included in the group that did not receive teprotumumab (control group). Teprotumumab treatment was associated with a significantly increased 5-year risk for all outcomes. They found a 2-fold risk for developing prediabetes and a 1.5 -fold risk for developing diabetes. Overall, 24% in the treated group had prediabetes versus 10% in control groups. The need to initiate antidiabetes medication was 1.6-fold increased in patients treated with teprotumumab. Overall, individuals at highest risk for hyperglycemia are females, patients ≥55 years of age, and White individuals.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Teprotumumab is a promising new treatment for the management of thyroid eye disease. It may cause worsening blood glucose control. The highest risk appears to be in women, individuals >55 years and white individuals. Continued monitoring of blood glucose levels and risk assessment is recommended for individuals who are undergoing this treatment.
— Alan P. Farwell, MD
ATA RESOURCES
Thyroid Eye Disease: https://www.thyroid.org/thyroid-eye-disease/
ABBREVIATIONS & DEFINITIONS
Autoimmune thyroid disease: a group of disorders that are caused by antibodies that get confused and attack the thyroid. These antibodies can either turn on the thyroid (Graves’ disease, hyperthyroidism) or turn it off (Hashimoto’s thyroiditis, hypothyroidism).
Teprotumumab (Tepezza™): a relatively new treatment for the management of thyroid eye disease (TED) that has shown excellent responses. It blocks the insulin-like growth factor 1 receptor (IGF-1R) inhibitor and has revolutionized the treatment of TED.
Thyroid eye disease (TED): also known as Graves ophthalmopathy. TED is most often seen in patients with Graves’ disease but also can be seen with Hashimoto’s thyroiditis. TED includes inflammation of the eyes, eye muscles and the surrounding tissues. Symptoms include dry eyes, red eyes, bulging of the eyes and double vision.
Graves’ disease: the most common cause of hyperthyroidism in the United States. It is caused by antibodies that attack the thyroid and turn it on.
Hashimotos thyroiditis: the most common cause of hypothyroidism in the United States. It is caused by antibodies that attack the thyroid and destroy it.
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