Pegvisomant in severe, treatment-resistant thyroid eye disease: a case report

Teprotumumab, a monoclonal antibody against the IGF1 receptor, has proven effective in the treatment of thyroid eye disease (TED). Pegvisomant reduces IGF1 levels through selective inhibition of growth hormone receptors. Here, we present a hypothesis-generating case of a 69-year-old patient with progressive TED. Pegvisomant 20 mg was administered daily for 90 days. IGF1 levels declined and remained low–normal during treatment. Clinical activity scores and VISA (vision, inflammation, strabismus and appearance) scores improved rapidly. MRI assessment showed that water content of both extraocular muscles and orbital connective tissue decreased after treatment. 99mTc-DTPA SPECT confirmed the decrease in disease activity. Further studies may confirm the efficacy of pegvisomant in TED. Download the Plain Language Summary of this article: https://www.drugsincontext.com/plain-language-summaries/plain-language-summary-pegvisomant-in-severe-treatment-resistant-thyroid-eye-disease-a-case-report