Autoimmune Thyroid Disease in the Use of Alemtuzumab for Multiple Sclerosis: A Review |
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| Affiliation: | 1. Department of Diabetes and Endocrinology, Gold Coast Hospital, Queensland, Australia;2. School of Medicine, Griffith University, Queensland, Australia;3. Department of Neurology, Gold Coast Hospital, Queensland, Australia.;1. Internal Medicine Department, Carlos Haya Hospital, Malaga, Spain;2. CIBER Fisiopatologia de la Obesidad y la Nutricion (CB06/003), Malaga, Spain;3. Preventive Medicine Department, Malaga University, Malaga, Spain;4. Health Center “Ciudad Jardin,” Malaga, Spain;5. Research Laboratory, Internal Medicine Department, Carlos Haya Hospital, Malaga, Spain;6. Endocrinology and Nutrition Department, Virgen de la Victoria Hospital, Malaga, Spain;7. Biomedical Research Laboratory, Endocrinology and Nutrition Department, Virgen de la Victoria Hospital, Malaga, Spain;1. Department of Endocrinology, Tan Tock Seng Hospital, Singapore;2. Yong Loo Lin School of Medicine, Singapore;3. Duke-NUS Graduate Medical School, Singapore;4. Brenner Centre for Molecular Medicine, National University of Singapore, Singapore;1. Department of Internal Medicine, Section of Endocrinology, Paris, France;2. Department of Internal Medicine, Paris, France;3. Department of Ophthalmology, Fondation Ophtalmologique A. de Rothschild. Paris, France.;1. Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York;2. Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, New York;3. Division of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;4. Department of Radiology, Jacobi Medical Center, Bronx, New York.;1. Minnesota Center for Obesity, Metabolism, and Endocrinology (MNCOME);2. Center for Nutrition and Metabolism, Division of Endocrinology, Nutrition, and Metabolism, Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada;3. Internist and Clinical Research Physician specializing in diabetes during pregnancy, Sansum Diabetes Research Institute;4. Director of Endocrinology, Minnesota Center for Obesity, Metabolism, and Endocrinology (MNCOME);5. Division of Endocrinology, Diabetes, Metabolism, Nutrition, College of Medicine, Mayo Clinic;6. CEO and Chief Scientific Officer, Sansum Diabetes Research Institute;7. Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, New York;8. Bone Densitometry Unit and Osteoporosis Center, Texas Institute for Reproductive Medicine and Endocrinology;9. Weight Loss and Diabetes Center, Endocrinology, Northeast Medical Group, Greenwich Hospital/Yale New Haven Health and Clinical Associate Professor of Medicine, Drexel University College of Medicine;10. Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University;11. Department of Nutritional Sciences, College of Health and Human Development, The Pennsylvania State University;12. Northwestern University Feinberg School of Medicine, Chicago, Illinois;13. Center for Nutrition and Metabolism, Division of Endocrinology, Nutrition, and Metabolism, Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada;14. Assistant Clinical Professor of Medicine, Center for Nutrition and Metabolism, Division of Endocrinology, Nutrition, and Metabolism, Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada, and Adjunct Associate Professor of Endocrinology and Internal Medicine, Touro University Nevada, College of Osteopathic Medicine;15. Center for Nutrition and Metabolism, Division of Endocrinology, Nutrition, and Metabolism, Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada;16. University of Pennsylvania School of Medicine, Department of Psychiatry, Center for Weight and Eating Disorders;17. Center for Nutrition and Metabolism, Division of Endocrinology, Nutrition, and Metabolism, Department of Internal Medicine, University of Nevada School of Medicine, Reno, Nevada.;1. Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut;2. Department of Pediatrics, College of Medicine of Peoria, University of Illinois |
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| Abstract: | ObjectiveThe monoclonal antibody alemtuzumab has been demonstrated to reduce the risks of relapse and accumulation of sustained disability in multiple sclerosis (MS) patients when compared to β-interferon. The development of autoimmune diseases, including thyroid disease, has been reported in the literature with a frequency of 20 to 30%. In this article, we describe 4 cases of alemtuzumab-induced thyroid disease in patients with MS. We also performed a systematic review of the available literature.MethodsFour patients who had received alemtuzumab for MS and subsequently developed thyroid dysfunction are presented. We compared our patients' clinical courses and outcomes to established disease patterns. We also undertook a systematic review of the published literature.ResultsAll 4 patients presented with initial hyperthyroidism associated with elevated thyroid-stimulating hormone (TSH) receptor antibodies (TRAb). In 2 cases, hyperthyroidism did not remit after a total of 24 months of carbimazole therapy, and they subsequently underwent subtotal thyroidectomy. The third case subsequently developed biochemical hypothyroidism and required thyroxine replacement, despite having a markedly raised initial TRAb titer. Autoimmunity following alemtuzumab therapy in MS appears to occur as part of an immune reconstitution syndrome and is more likely in smokers who have a family history of autoimmune disease.ConclusionManagement of alemtuzumab-induced thyroid disease is similar to the management of “wild-type” Graves’ disease. The use of alemtuzumab in this setting will necessitate close monitoring of thyroid function and early intervention when abnormalities are developing. (Endocr Pract. 2013;19:821-828) |
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