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Alemtuzumab – Thyroid Autoimmunity — SCE Neurology MCQ

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ModerateMultiple Sclerosis & CNS InflammationAlemtuzumab – Thyroid AutoimmunitySCE Neurology

A 42-year-old woman with RRMS on alemtuzumab develops new onset palpitations and weight loss 18 months after her last infusion. Blood tests show suppressed TSH and elevated free T4. What is the most likely diagnosis?

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Correct answer: CGraves disease secondary to alemtuzumab-induced autoimmunity

Alemtuzumab-induced thyroid autoimmunity is the most common secondary autoimmune complication, occurring in approximately 40% of treated patients. Graves disease (with TSH receptor antibodies) is the most frequent thyroid disorder, though Hashimoto thyroiditis also occurs. Monthly thyroid function monitoring is mandatory for at least 48 months after the last alemtuzumab dose. Treatment is standard for Graves disease (carbimazole, radioiodine, or surgery). A: This is the most likely cause given the timing. B: Hashimoto causes hypothyroidism, not thyrotoxicosis. C: Thyroid storm is a complication of untreated hyperthyroidism. D: Subacute thyroiditis is post-viral. E: Pituitary adenoma would cause elevated TSH.

Reference: NICE TA312 Alemtuzumab (2014); Alemtuzumab SmPC