Multidisciplinary management of thyroid eye disease (TED) in patients with latent tuberculosis or chronic hepatitis B
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Background
Intravenous methylprednisolone (IVMP) is a first-line treatment for active moderate-severe or sight-threatening thyroid eye disease (TED), but the presence of systemic infections such as latent tuberculosis (TB) or chronic hepatitis B virus (HBV) act as relative contraindications due to the risk of reactivation. There is limited data to guide clinicians in this high-risk group.
Methods
A retrospective case series was conducted involving five TED patients with relative contraindications to immunosuppression. Each patient included had a EUGOGO severity of moderate-to-severe. Multidisciplinary team (MDT) input guided treatment planning. Patients either received IVMP with or without mycophenolate mofetil (MMF) alongside management of their systemic infection or were observed. TED outcomes, infection status, and adverse events were monitored.
Results
Three patients had latent TB and received isoniazid ± rifampicin prophylaxis with two having conservative TED management, due to high-risk features of their TB, and one receiving IVMP with MMF. Two patients had chronic HBV and underwent IVMP therapy with tenofovir or entecavir. No systemic infection progression or adverse events were observed during follow-up. All treated patients showed improvement in Clinical Activity Score (CAS) and improved or stable Graves’ Ophthalmopathy Quality of Life (GO-QOL) scores.
Conclusions
Immunosuppression can be safely initiated in TED patients with systemic infections using a multidisciplinary approach. Early screening, judicious patient selection, coordinated care, and prophylactic treatment are key to balancing efficacy with risk mitigation.
Intravenous methylprednisolone (IVMP) is a first-line treatment for active moderate-severe or sight-threatening thyroid eye disease (TED), but the presence of systemic infections such as latent tuberculosis (TB) or chronic hepatitis B virus (HBV) act as relative contraindications due to the risk of reactivation. There is limited data to guide clinicians in this high-risk group.
Methods
A retrospective case series was conducted involving five TED patients with relative contraindications to immunosuppression. Each patient included had a EUGOGO severity of moderate-to-severe. Multidisciplinary team (MDT) input guided treatment planning. Patients either received IVMP with or without mycophenolate mofetil (MMF) alongside management of their systemic infection or were observed. TED outcomes, infection status, and adverse events were monitored.
Results
Three patients had latent TB and received isoniazid ± rifampicin prophylaxis with two having conservative TED management, due to high-risk features of their TB, and one receiving IVMP with MMF. Two patients had chronic HBV and underwent IVMP therapy with tenofovir or entecavir. No systemic infection progression or adverse events were observed during follow-up. All treated patients showed improvement in Clinical Activity Score (CAS) and improved or stable Graves’ Ophthalmopathy Quality of Life (GO-QOL) scores.
Conclusions
Immunosuppression can be safely initiated in TED patients with systemic infections using a multidisciplinary approach. Early screening, judicious patient selection, coordinated care, and prophylactic treatment are key to balancing efficacy with risk mitigation.
Date Issued
2026-01-29
Date Acceptance
2025-12-22
Citation
Thyroid Research, 2026, 19 (1)
ISSN
1756-6614
Publisher
BMC
Journal / Book Title
Thyroid Research
Volume
19
Issue
1
Copyright Statement
© The Author(s) 2026. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
License URL
Identifier
10.1186/s13044-025-00283-2
Subjects
TED
Immunosuppression
IVMP
Tuberculosis
MDT
Hepatitis
GO-QOL
Publication Status
Published
Article Number
ARTN 6