Clinical Thyroidology® for the Public
Summaries for the Public from recent articles in Clinical Thyroidology
Table of Contents | PDF File for Saving and Printing
THYROID EYE DISEASE
Long-term impact of teprotumumab (Tepezza™) on blood glucose levels
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, one of the side effects of this medication is increased blood glucose levels in patients with and without diabetes. This evaluates a long-term group of patients to quantify the severity and implications of teprotumumab-induced hyperglycemia.
THE FULL ARTICLE TITLE
Ha SK, et al. Longitudinal glycemic outcomes in patients with thyroid eye disease treated with Teprotumumab. Ophthalmic Plast Reconstr Surg 2025.
SUMMARY OF THE STUDY
This study was conducted at the Massachusetts Eye and Ear Infirmary, capturing clinical data from January 1, 2020, to March 31, 2025. Inclusion required adult patients initiating teprotumumab for TED to have documented hemoglobin A1c measurements both prior to and after starting treatment. A total of 71 patients (average age 58 years; 71.8% female) with an average follow-up of 28 months. Of these patients slightly more than half developed worsening blood glucose control. The patients who had diabetes showed peak worsening of blood glucose control around 5 months (A1c increase 1.4%), whereas those individuals who did not have diabetes peaked around 13 months (A1c increase 0.3-0.5%). In addition, only about a third of these patients had restoration of normal blood glucose control after treatment. These A1c elevations occurred uniformly across normal, overweight, and obese BMIs.
WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Teprotumumab is a promising new treatment for the management of thyroid eye disease. It may cause worsening of blood glucose control. However, the time of onset appears to be dependent on the presence or absence of diabetes prior to use of this medication. Continued monitoring of blood glucose levels and risk assessment is recommended for individuals who are undergoing this treatment.
— Vibhavasu Sharma, MD, FACE
ATA THYROID BROCHURE LINKS
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).
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.
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.
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.
AMERICAN THYROID ASSOCIATION® , ATA® , THYROID® , CLINICAL THYROIDOLOGY® , and the distinctive circular logo are registered in the U.S. Patent and Trademark Office as trademarks of the American Thyroid Association® , Inc.© 2026 American Thyroid Association.
