Endocrine Abstracts

Alemtuzumab is a monoclonal antibody used in the treatment of relapsing-remitting multiple sclerosis (RRMS). Thyroid dysfunction is a common side effect. Alemtuzumab induced Graves’ disease (AIGD) is notable for its fluctuating and unpredictable course. We present the case of two women with RRMS who required total thyroidectomy to manage AIGD and were followed up in our antenatal endocrine clinic during their pregnancy. The first patient is a 31-year-old lady who developed AIGD one year after initiation of alemtuzumab. Her thyrotoxicosis remained difficult to control on high dose carbimazole and she underwent total thyroidectomy 18 months after the initial diagnosis. She presented to our antenatal endocrine clinic 3 years later. Her thyroid function tests (TFTs), as well as her thyroid stimulating hormone receptor antibodies (TRABs), were monitored throughout her pregnancy. The latter remained positive 4 years after her initial diagnosis and 5 years after her last alemtuzumab course, therefore, an ultrasound to look for foetal goitre was arranged in her 3rd trimester and the baby was monitored for signs of thyrotoxicosis post-delivery. Our second patient is a 40-year-old lady who developed AIGD three years after initiation of alemtuzumab. She had a history of several miscarriages and was actively seeking conception. In view of her age, total thyroidectomy was recommended in preparation for pregnancy. She was treated with a block and replace regimen whilst surgery was awaited. She underwent total thyroidectomy 3 months after her initial presentation and is now in her 2nd trimester of pregnancy, with TFTs being monitored every trimester. Total thyroidectomy should be considered in women of reproductive age with AIGD, especially if their hyperthyroidism is difficult to control or there are immediate plans for conception. TRABs should be monitored during pregnancy in these patients, as they can remain positive several years after alemtuzumab is stopped.