Abstract Listings 2024

Purpose

Prior studies have demonstrated less severe TED (thyroid eye disease) requiring less aggressive management in patients under the age of 40. The purpose of this study was to characterize the unique clinical trajectories of two young patients with Graves’ disease and severe, active TED in the setting of cannabis use.

Methods

This is a case series of two patients with active cannabis use and severe TED treated at a single institution.

Results

Patient 1 was a 21-year-old Caucasian male who used cannabis daily and whose TED symptoms were concurrent with the diagnosis of Graves’ disease in the setting of proptosis and unintentional weight loss. His presenting symptoms were diplopia in upgaze, proptosis, and severe eyelid swelling. The Clinical Activity Score (CAS) at the time of presentation 6/7. He received teprotumumab with significant improvement in proptosis and CAS of 1/10 by final infusion. Six months after completing the course, with continued cannabis use, he reactivated with a CAS 9/10 which improved to 6/10 after 2 doses of the second round of teprotumumab at his 20 month follow-up. Patient 2 was a 21-year-old Asian male who reported weekly cannabis use at the time of TED diagnosis. At presentation, he reported severe pain and diplopia in all gazes, except primary, and was found to have bilateral lower lid retraction with edema and injection. CAS was 4/7 at presentation which improved to 1/10 after 7 out of 8 infusions of teprotumumab at 7 month follow-up.

Conclusion

These two young patients presented with active cannabis use and severe, inflammatory TED requiring aggressive management. This is unusual given the expected phenotype of young patients having minimal inflammatory signs with TED. Physicians should consider advising TED patients to avoid cannabis use and encourage cessation.

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