Extraocular muscle volume reduction in a patient treated with two courses of teprotumumab for thyroid eye disease - Case report

Sep 28, 2026

Purpose: Report MRI extraocular muscle (EOM) volume analysis in a thyroid eye disease (TED) patient treated with two full courses of teprotumumab. Observations: An 84-year-old man received two teprotumumab courses (16/16, then 8/8). After the first course, symptoms improved but reactivated 7 months later; follow-up MRI showed reduced EOM volume despite recurrent symptoms. A second course improved clinically, and a third MRI 6 months later showed further EOM volume reduction. Conclusion: Continued radiographic and clinical improvement may occur after retreatment; further studies are needed to define EOM volume as a marker.

LanguageEnglish

CategoryHealthcare

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Pages5

Reading Time13 min

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Introduction

Case presentation

Abstract and conclusion

American Journal of Ophthalmology Case Reports 41 (2026) 102490 Contents lists available at ScienceDirect American Journal of Ophthalmology Case Reports journal [homepage:](homepage: www.ajocasereports.com/)[ www.ajocasereports.com/](homepage: www.ajocasereports.com/) | Extraocular muscle volume reduction in a patient treated with two courses of teprotumumab for thyroid eye disease
Hanna Richkinda , Marissa K. Shoji b , Megan Routzongc , David Graneta, Don O. Kikkawab, Jolene C. Rudella,*
a Ratner Children’s Eye Center of the Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
b Division of Oculofacial Plastic and Reconstructive Surgery, Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California San Diego, La Jolla, CA, USA
c Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, Sanford Consortium for Regenerative Medicine, La Jolla, CA, 92037, USA | | | | --- | --- | --- | | A R T I C L E I N F O | | A B S T R A C T | | Keywords:
Extraocular muscle volume Graves’ disease Teprotumumab
Thyroid eye disease Retreatment | | Purpose: To report magnetic resonance imaging (MRI) extraocular muscle (EOM) volume analysis in a patient with thyroid eye disease (TED) who was treated with two full courses of teprotumumab.
Observations: An 84-year-old man with TED received two full courses (16/16 infusions) of teprotumumab. At the initial presentation, he had decreased visual acuity, proptosis, and diplopia. Imaging at this time illustrated enlarged EOMs, predominantly on the left side. After his first course of teprotumumab, his symptoms improved. However, he experienced disease reactivation 7 months later. A follow-up MRI revealed reduced EOM volume compared to baseline, though the patient reported recurrent symptoms. A second course of teprotumumab (8/8 infusions) was initiated, leading to clinical improvement. Six months after completion of his second teprotumumab course, a third MRI showed further reduction in EOM volumes compared to both baseline and preretreatment imaging.
Conclusion: This case demonstrates the potential for continued radiographic and clinical improvement in TED patients after retreatment with teprotumumab. Further studies may clarify the role of EOM volume as a marker for treatment efficacy. | 1. Introduction Thyroid eye disease (TED) is a complex autoimmune disorder affecting the orbital soft tissues. Patients may experience symptoms such as conjunctival injection, blurry vision, photophobia, diplopia, and swelling of the eyelids, as well as potentially vision-threatening sequelae including compressive optic neuropathy or exposure keratopathy.1 Mild disease may be treated through observation and conservative treatments such as topical lubricants. Moderate/severe cases can be treated with anti-inflammatory medications such as steroids and surgical procedures including orbital decompression, strabismus surgery, and eyelid repair.2 Teprotumumab (Tepezza, Amgen), a monoclonal insulin-growth factor type 1 receptor (IGF-1R) inhibitory antibody, was approved by the Food and Drug Administration in 2020 for TED.3 It has demonstrated efficacy in reducing proptosis and orbital soft tissue volume but may cause side effects such as hyperglycemia, hearing loss, and muscle spasms.4 Additionally, while teprotumumab has been shown to significantly improve symptoms of TED in many patients, some patients experience regression or reactivation, and it has been suggested that such patients may benefit from additional treatment.5 However, due to a limited number of studies that investigate the retreatment of teprotumumab for TED, its role in specific clinical situations is unclear; moreover, the effect of re-treatment on the extraocular muscles (EOMs) including associated radiographic changes has not yet been reported. Herein we present a case of an 84-year-old male patient with TED who complet

FAQs

What was the purpose of this case report?

To report MRI-based extraocular muscle volume analysis in a patient with thyroid eye disease treated with two full courses of teprotumumab.

How did the patient respond after the first teprotumumab course?

Symptoms such as decreased visual acuity, proptosis, and diplopia improved, but the disease reactivated about 7 months later.

What did the imaging show after retreatment?

After retreatment, follow-up MRI demonstrated reduced EOM volume compared with baseline, and a third MRI six months after the second course showed further reduction alongside clinical improvement.

Sep 28, 2026

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