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  • Oculoplastics/Orbit

    Review of: Menstrual irregularities and amenorrhea in thyroid eye disease patients treated with teprotumumab

    Terrarosa A, DeMaria L, North V, et al. Ophthalmic Plastic and Reconstructive Surgery, May/June 2024

    A study specifically designed to assess the effects of teprotumumab therapy on menstruation has found a high rate of menstrual irregularities. However, these effects largely reversed after 3 months of treatment cessation.

    Study Design

    This was a retrospective review of data from 12 female patients with baseline regular menstruation (mean age 38.3 years [range 25–53 years]) who completed 8 infusions of teprotumumab for active thyroid eye disease (TED). Patients were then queried during their regular office visits about amenorrhea or irregularities in menstruation both during and after treatment. The average time of follow-up was 11.4 months after cessation of treatment.


    Overall, 3 patients reported no change in their baseline menstruation, 3 patients reported menstrual irregularities, and 6 reported a total loss of menstruation for at least 3 months, translating to a side effect rate of 75%. Menstrual changes were noted after an average of 3.2 infusions. Four patients experienced irregularities only during treatment, and menstruation returned to baseline in 3 patients at an average of 3 months after completing treatment. One patient (aged 53 years) reported persistent amenorrhea, which may possibly have been related to menopause, while another patient had persistent menorrhagia 4 months after cessation of treatment.


    The study was limited by its small population and the reliance on patient recall of symptoms. Menstruation-related side effects would be better studied in a larger cohort designed to prospectively evaluate patients for this issue.

    Clinical Significance

    As the number of patients being treated with teprotumumab for TED increases, the side effect profile of the medication is becoming better defined. The wide range of side effects is likely due to the ubiquitous nature of insulin-like growth factor 1 receptor throughout the body. Previous studies have noted menstrual irregularities as a side effect in women being treated with teprotumumab, occurring at a rate of ~23%. Physicians should discuss this potential side effect with their pre- or perimenopausal female patients who are considering teprotumumab therapy.

    Financial Disclosures: Dr. Richard Allen discloses no financial relationships.