Purpose

To describe the characteristics and treatment of thyroid eye disease (TED) in patients with multiple sclerosis (MS).

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Methods

A retrospective review of all TED patients with MS in a tertiary TED MDT was undertaken.

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Results

Eight female patients with MS diagnosed aged 23–43 years (median peak EDSS 5.75) previously received immune reconstitution therapy (IRT): five with alemtuzumab and two with autologous hematopoietic stem cell transplantation (AHSCT) and one treated with both. All were previously euthyroid and developed Graves hyperthyroidism (GH) after MS (135.5 months (range 31 – 299 months) and IRT (median interval 34.5 months, 12-49).
TED developed a median of 12 months (2-35) after GH. Presenting CAS was ≤ 3 in 7 patients. Baseline EUGOGO severity scale was moderate-severe in six patients and mild in two. Baseline diplopia was absent in 5, intermittent in 2, and constant in 1. Diplopia severity worsened in one patient and improved in another. Typical MRI findings showed extraocular muscle inflammation changes, with two cases of apical crowding. TED treatment included intravenous methylprednisolone (n=4), local triamcinolone (n=3), orbital decompression (n=2), strabismus surgery (n=2) and lid surgery (n=1). Median GO-QoL appearance scores worsened from 50 to 41.88 at final assessment and visual function decreased from median 76.31 to 58.34.

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Conclusion

Alemtuzumab and AHSCT were associated with the onset of GH and TED. Ofatumumab was temporally related with TED-reactivation in one patient. Therapy-associated TED is heterogeneous and often inactive despite moderate-severe severity. Long-term surveillance with MDT input is important in this population.

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Additional Authors

First name	Last name	Base Hospital / Institution
Sandhi	Nyunt	Central Middlesex Hospital, London North West NHS Trust
Anshul	Radotra	Western Eye Hospital, Imperial College NHS Trust
Claire	Feeney	Charing Cross Hospital, Imperial College NHS Trust
Richard	Nicholas	Charing Cross Hospital, Imperial College NHS Trust
Kunwar	Bhatia	Charing Cross Hospital, Imperial College NHS Trust
Vickie	Lee	Western Eye Hospital, Imperial College NHS Trust

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