Abstract:
Background. Thyroid orbitopathy (OT) represents a complex autoimmune condition with
a varied ocular clinic such as diplopia, diminished vision and progressive alterations in facial
appearance. Traditional treatments show limited efficacy regarding the structural
components of the disease such as proptosis and diplopia.
Objective(s). Highlighting innovative treatment methods in OT particularly focusing on
targeted biological treatment represented by Teprotumumab - a monoclonal antibody
directed against the IGF-1R receptor.
Materials and methods. Review of current data analyzing PubMed, ScienceDirect and
Elsevier scientific publications and articles, published between 2016-2022 regarding the
pathogenetic mechanism of OT, underlining the results obtained regarding the efficacy of
teprotumumab - the antibody directed against the insulin-like growth factor receptor 1.
Results. By blocking the IGF-1R/TSHR pathway, teprotumumab reduces the release of
proinflammatory cytokines. This causes the stimulation of orbital fibroblasts and the
deposition of hyaluronan - thus contributing to the expansion of adipose tissue and
extraocular muscle, the development of edema and inflammation. Therefore, this
monoclonal antibody can reduce the signaling initiated at either receptor, blocking any
pathological immune response in Thyroid Orbitopathy. Its efficacy in reducing proptosis,
improving diplopia and decreasing disease activity has led to its approval as the first
targeted biologic treatment for OT.
Conclusion(s). Recent clinical studies with reference to the pathogenesis of thyroid
orbitopathy indicate an advanced transition from nonspecific anti-inflammatory therapies
to individualized biological approaches. Therefore, teprotumumab marks a significant
advance in this direction.
