Clinical and magnetic resonance imaging outcomes of teprotumumab in a Japanese thyroid eye disease cohort: comparison of patients with and without dysthyroid optic neuropathy.

Authors

Muhammad Abumanhal, Mizuki Tagami, Taichi Higashida, Gen Kinari, Yasuhiro Takahashi

Published in

Canadian journal of ophthalmology. Journal canadien d'ophtalmologie. Aug 24, 2026. Epub Aug 24, 2026.

Abstract

To evaluate and compare the clinical and magnetic resonance imaging (MRI)-based radiologic outcomes of teprotumumab treatment between patients with active thyroid eye disease (TED) with and without dysthyroid optic neuropathy (DON).
Retrospective multicentre study.
Patients with active moderate-to-severe or sight-threatening TED who completed teprotumumab treatment and a 3-month follow-up after treatment completion.
Patients were classified according to the presence or absence of DON. Clinical evaluation included clinical activity score, visual acuity, Hertel exophthalmometric values, and thyroid-stimulating antibody activity. MRI-based quantitative analyses included measurements of extraocular muscle (EOM) volume on T1-weighted images and signal intensity ratio on short tau inversion recovery MRI.
Thirty-one patients were included, comprising 24 patients without DON and 7 patients with DON. After teprotumumab treatment, significant improvements or reductions were observed in visual acuity, clinical activity score, Hertel exophthalmometric values, thyroid-stimulating antibody activity, EOM volume, and signal intensity ratio in all rectus muscles (all P < 0.05). Follow-up MRI showed complete resolution of high-signal inflammatory lesions in all patients. Patients with DON demonstrated significantly greater EOM volume reduction compared with patients without DON (P < 0.050). Adverse events occurred in 77.4% of patients, most commonly otologic symptoms and muscle cramps, although no patient required permanent treatment discontinuation.
Teprotumumab demonstrated significant clinical and radiologic efficacy in patients with active TED, including those with DON. MRI revealed marked reductions in orbital inflammation and EOM enlargement after treatment, supporting the value of MRI as an objective tool for assessing disease activity and treatment response.

PMID:
42637225
Bibliographic data and abstract were imported from PubMed on 25 Aug 2026.

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