Teprotumumab-associated aural fullness and ageusia: A case report of persistent complications following thyroid eye disease treatment

Purpose

As an inhibitor of the insulin-like growth factor-1 (IGF-1) receptor, teprotumumab is utilized in the treatment of thyroid eye disease (TED) in which there is overexpression of IGF-1 receptors by orbital fibroblasts. Clinical trials and additional studies have brought the otologic side effects of the drug to attention. Discontinuing the drug leads to resolution in some patients, whereas others report chronic symptoms, including hearing loss. Gustatory side effects have not been elucidated to the same degree, and there are no specific recommendations on how to screen for or address otologic or gustatory complications of teprotumumab. This case report details the course of a patient with prolonged aural fullness and ageusia following teprotumumab treatment.

Design and Methods

Case report.

Results

A 71-year-old woman presenting with thyroid eye disease underwent seven cycles of teprotumumab infusion therapy. Her symptom profile, including aural fullness and ageusia, led to treatment cessation prior to completion of her final infusion. Following this treatment course, her thyroid eye disease clinical activity score improved and almost all her medication-associated adverse effects resolved.

Conclusion

This report highlights the first documented case of ageusia, and an unusually protracted course of aural fullness, with teprotumumab use. The case affirms the value of otologic and gustatory screening and continued evaluations before, during, and after receiving teprotumumab, and further characterizes aural fullness and ageusia as potential lasting consequences of therapy.