A case of autoimmune thyroid disease with Alemtuzumab therapy
D Hirani, M Moriarty, S Khan, S Jarvis, T Ladha, Z Halil, A Mahmood, V Bravis. Affiliations: St Mary’s Hospital Endocrinology Department, Imperial Healthcare NHS Trust, London
Abstract: We present the case of a 42-year-old female with a history of relapsing-remitting multiple sclerosis. She received a course of Natalizumab between 2013 and 2015, followed by Alemtuzumab in 2015 and 2016. Her monitoring blood tests with the multiple sclerosis clinical nurse showed TSH <0.01 mU/L, T3 5.5 pmol/L, T4 18.3 pmol/L, and negative thyroid peroxidase antibody. She had no clinical features of hyperthyroidism and reported no visual symptoms. Of note, she had a family history of type 1 diabetes and had been previously investigated under the endocrine team for reactive hypoglycaemia. Her symptoms were eventually successfully controlled with dietary interventions.
She was initially started on 5mg Carbimazole for subclinical thyrotoxicosis, which was gradually up-titrated to 30mg Carbimazole within 12 months, according to serial thyroid function tests. Although initially reluctant, she agreed to subsequently change to a “block-and-replace” regimen after further consultation to account for fluctuations in thyroid function tests
Conclusion: Alemtuzumab, a monoclonal antibody binding the CD52 antigen, is a treatment for active multiple sclerosis. However, autoimmunity is an adverse side effect, with thyroid autoimmune disease affecting up to 33% of patients established on the therapy. Autoimmune thyroid disease following a course of Alemtuzumab is a common adverse side effect. Regular thyroid function monitoring is required, with subsequent tailored treatment according to thyroid status.
1. Alina Sovetkina, Rans Nadir, Antonio Scalfari, Francesca Tona, Kevin Murphy, Eleonora Rigoni, Rachel Dorsey, Omar Malik, Ashwini Nandoskar, Victoria Singh-Curry, Richard Nicholas, Niamh Martin, Development of Autoimmune Thyroid Disease in Multiple Sclerosis Patients Post-Alemtuzumab Improves Treatment Response, The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 9, September 2020, Pages e3392–e3399,