Abstract #1413021: Teprotumumab Induced Type 1 Diabetes Mellitus

Thyroid Eye disease is a potentially vison impairing condition for which Teprotumumab has emerged as premier option in managing activity. The primary mechanism of action monoclonal antibody against the insulin-like growth factor-I receptor but large portion remains unknown. In original trial about 10% patients developed hyperglycemia was described self limited and mild. Since commercial release there been great heterogeneity shown with case reports HHS DKA despite third returning to baseline after completion therapy. We present type 1 diabetes starting may help advise decisions therapy, monitoring, surveillance. A 52-year-old female prediabetes (A1C 6.1%), mild hypothyroidism tobacco use who presents diplopia, proptosis, palpitations January 2022 PCP. She had lab work performed March TSH 0.007, FT4 2.45, TPO antibodies 219 positive. Last normal TFTs Feb 2020. Her levothyroxine stopped by PCP she started on methimazole 10 mg tid propranolol ER 60 daily. April referred Endocrinology, Labs: TSI index 2.9, now 13, Free T4 0.56 (0.93 - 1.7) while tid. reduced bid Ophthalmology co-management thyroid eye plan moderate severe disease. Subsequent follow up June 2022, tapered down 5 between visits labs showed: 0.074, 1.08, FT3 3.8. Methimazole further metformin XR 500 given her diagnosis achieved smoking cessation varenicline. CBC LFT monitoring were remarkable chronic ALP elevation. symptoms improved significantly second infusion. Hyperglycemia worsened A1C increased 7.5%.TSH 6.32 1.1 methimazole. Subsequently decreased 2.5 daily Metformin 1g addition glimepiride 2mg continued hyperglycemia. we obtained GAD remission. >125 exceeding beyond upper limit assay subsequent tests c-peptide are pending at this time. revolutionized treatment. This demonstrates multiple modalities that be non-reversible Teprotumumab. importance perhaps role evaluating insulin reserve induced supports group heterogenous needs studies. Further evaluation patient still initiation hope can guide research, safety protocols, awareness management