Thyroid-Like Ophthalmopathy in a Euthyroid Patient Receiving Ipilimumab
Abstract
A 68-year-old lady with metastatic malignant melanoma was treated with Ipilimumab. She presented to Eye Casualty unable to move her eyes. Physical examination confirmed ophthalmoplegia and identified proptosis bilaterally. Radiological imaging showed bilateral enlargement of all the extra-ocular muscles suggestive of thyroid eye disease. Laboratory investigations found this patient to be euthyroid. A diagnosis of thyroid-like orbitopathy secondary to Ipilimumab therapy was made. Thyroid function tests should be performed for all patients prior to their commencement of Ipilimumab. Thyroid-like eye disease may develop in patients treated with Ipilimumab even if they remain euthyroid.
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In the literature, only nine cases of ICPi-induced Graves' hyperthyroidism and seven cases of induced Graves' orbitopathy have been described, associated with anti-PD-1 or anti-CTLA-4 treatment or their combination, with only one patient presenting both thyrotoxicosis and orbitopathy.
“To the best of our knowledge at the time of writing, only nine cases of ICPi-induced Graves’ hyperthyroidism and seven cases of induced Graves’ orbitopathy have been described in the literature, associated with anti-PD-1 or anti-CTLA-4 treatment or their combination (Table 3), with only one patient presenting with both thyrotoxicosis and orbitopathy [19,29,30,31,35,36,37,38,39,40,41,42,43,44].”
From Graves’ Disease during Immune Checkpoint Inhibitor Therapy (A Case Series and Literature Review) (2021) · cites this paper as [29]
Initially only induced Graves' orbitopathy without thyrotoxicosis were described in patients undergoing Ipilimumab treatment.
“In the literature, initially only induced Graves’ orbitopathy (GO) without thyrotoxicosis were described in patients undergoing Ipilimumab (anti-CTLA-4) treatment [29,30,31].”
From Graves’ Disease during Immune Checkpoint Inhibitor Therapy (A Case Series and Literature Review) (2021) · cites this paper as [29]
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- Authors
- McElnea, E., Ní Mhéalóid, Á., Moran, S., Kelly, R., & Fulcher, T.
- Affiliations
- Mater Misericordiae University Hospital (IE)
- Corresponding author
- McElnea, Elizabeth
- Venue
- Orbit
- Publisher
- Informa UK Limited
- Published
- 2014-09-10
- Volume
- 33
- Issue
- 6
- Pages
- 424-427
- ISSN
- 0167-6830 (ISSN-L)
- 1744-5108
- OpenAlex
- W2135738164
- Cited by
- 93
- References
- 17
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 10 · 2023: 4 · 2022: 7 · 2021: 7 · 2020: 9 · 2019: 7 · 2018: 15 · 2017: 7 · 2016: 14 · 2015: 4 · 2014: 1
- FWCI
- 6.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Orbit (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Oncology › Cancer Immunotherapy and Biomarkers
- Health Sciences › Medicine › Ophthalmology › Drug-Induced Ocular Toxicity
- Keywords
- ipilimumab, immune-related adverse events, ophthalmoplegia, proptosis, extraocular muscle enlargement, metastatic melanoma, thyroid function tests
- MeSH terms
- Ipilimumab, Aged, Antibodies, Monoclonal, Euthyroid Sick Syndromes, Exophthalmos, Female, Glucocorticoids, Humans, Melanoma, Methylprednisolone, Ophthalmoplegia, Thyroid Function Tests, Thyrotropin, Thyroxine, Graves Ophthalmopathy
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