Teprotumumab-associated persistent unilateral hearing loss in dysthyroid optic neuropathy: a case report with review of the literature.
Yuji Hiromatsu, Kumiko Suzuki, Shiho Watanabe et al.
✦ AI-curated · Sources linked
Case in brief
A 55-year-old woman with Graves’ disease and severe thyroid eye disease complicated by dysthyroid optic neuropathy had an insufficient response to high-dose intravenous steroids. Teprotumumab markedly improved her proptosis, orbital inflammation, and visual function, but auditory symptoms began after the fifth infusion and progressed to sensorineural hearing loss. After the eighth and final infusion, right-ear thresholds worsened, particularly at low to mid frequencies, despite oral prednisolone; the right-ear PTA4 reached 75.00 dB HL at twenty days. Audiograms through 198 days after the final infusion showed no recovery.
What made this case unusual
The hearing loss progressed after teprotumumab was completed and remained unrecovered on serial testing. The patient also had a history of sudden sensorineural hearing loss, which the authors considered a possible marker of increased susceptibility.
Diagnostic / clinical pearl
New aural fullness or sound reverberation during teprotumumab treatment may precede progressive sensorineural hearing loss; audiologic monitoring is relevant, particularly when there is a prior history of sudden hearing loss.
Why it matters
The case highlights the need to weigh visual benefit against potentially persistent auditory toxicity through individualized risk assessment and shared decision-making.