Alemtuzumab autoimmune thyroid disease — SCE Neurology MCQ

Correct answer: E — Alemtuzumab-related thyroid autoimmunity requiring endocrine treatment and continued post-treatment safety monitoring after specialist review

The best answer is “Alemtuzumab-related thyroid autoimmunity requiring endocrine treatment and continued post-treatment safety monitoring after specialist review”. Secondary autoimmune thyroid disease is a recognised delayed complication; scheduled thyroid monitoring must continue for the required post-treatment period. “A brainstem multiple-sclerosis relapse requiring methylprednisolone” can be reasonable in another presentation, but it does not account for the defining feature here. “A benign adrenergic effect that needs no investigation” can be reasonable in another presentation, but it does not account for the defining feature here. “A dopamine-withdrawal syndrome” can be reasonable in another presentation, but it does not account for the defining feature here. “A reason to stop all thyroid monitoring because treatment ended over a year ago” can be reasonable in another presentation, but it does not account for the defining feature here.

Reference: MHRA alemtuzumab safety update: https://www.gov.uk/drug-safety-update/lemtrada-alemtuzumab-updated-restrictions-and-strengthened-monitoring-requirements-following-review-of-serious-cardiovascular-and-immune-mediated-reactions