Endocrine Abstracts

Objectives: Graves’ hyperthyroidism is a frequent complication of alemtuzumab treatment in MS. We present the case of an MS patient who developed clinically and biochemically overt alemtuzumab-induced Graves’ disease, remitting 6 months after treatment with ocrelizumab and methylprednisolone pulse-therapy.

Methods: A 49-year-old man diagnosed with active multiple sclerosis who had undergone alemtuzumab treatment, and developed Graves’ hyperthyroidism which remitted after ocrelizumab and pulse-therapy with methylprednisolone. Clinical symptoms of Graves’ disease and thyrotropin antibody titres were frequently evaluated as well as multiple sclerosis clinical and paraclinical parameters.

Results: Seven months after the second alemtuzumab course the patient developed a symptomatic Graves’ hyperthyroidism with very high thyrotropin antibody titres, which was treated with anti-thyroid drugs. Two years later ocrelizumab was started along with methylprednisolone in pulse-therapy due to a multiple sclerosis relapse, with subsequent remission of the hyperthyroidism. Six months later the antibodies decreased and the anti-thyroid drugs were stopped. 24 months later he remains euthyroid.

Discussion: This case highlights the possibility of remission of post-alemtuzumab Graves’ disease after methylprednisolone pulse-therapy and ocrelizumab with avoidance of further medical or surgical treatment.