{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T09:32:15Z","timestamp":1786613535192,"version":"build-2736575974"},"reference-count":17,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Alemtuzumab (Lemtrada) is highly effective for selected relapsing multiple sclerosis (MS) but can cause autoimmune thyroid dysfunction (AITD). Our aim was to retrospectively review patients and the monitoring of their thyroid function tests (TFTs) during and after treatment with alemtuzumab. We wanted to summarise the incidence and characterise the nature of TD in our Northern Ireland (NI) cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data was obtained from the NI Disease Modifying Treatment (NIDMT) database for all patients with relapsing remitting MS receiving alemtuzumab in the period between 2015 and 2024. Patients were identified and data collected retrospectively from clinical records. Data collected included dates of alemtuzumab treatment, TFT monitoring results, subsequent follow up and any thyroid treatment required. Demographic and clinical data were obtained from the Northern Ireland Electronic Care Record (NIECR)\u2014an electronic healthcare record.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      168 patients (female\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009114, male\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200954) received alemtuzumab between 2015 and 2024 in Northern Ireland, with a follow\u2010up period of approximately 60 months. On most recent follow up, TD occurred in 45.8% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200977) patients. The spectrum of thyroid disorders observed post\u2010alemtuzumab was diverse; Graves' disease and thyroiditis were the most common thyroid disorders, each affecting 10.7% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200918) of patients. Thyroiditis with positive thyroid stimulating receptor antibodies (TRAb) occurred in 7.7% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913), followed by Hashimoto's disease 7.1% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200913), with both ab\u2010negative hypothyroidism 6.0% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910) and hyperthyroidism 3.0% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095). Two patients had pre\u2010existing thyroid dysfunction hypothyroidism\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091 and hyperthyroidism\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091. Baseline thyroid autoantibody status showed a strong association with TD. Women were twice as likely as men to develop TD following Alemtuzumab treatment. Neither age nor MS duration significantly influenced the risk of TD. TD was diagnosed as early as 12 months after initiating treatment, with the latest diagnosis being made 56 months after.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The frequency of Alemtuzumab\u2010induced TD in our cohort was similar to that reported in other literature and the nature of TD varied with a number of patients fluctuating between dysthyroid states. This data highlights the importance of close surveillance for TD due to the risk of complex, late\u2010onset autoimmunity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/cen.70201","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T09:22:08Z","timestamp":1786612928000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence, Patterns and Predictors of Alemtuzumab\u2010Induced Thyroid Dysfunction in Patients With Multiple Sclerosis: A Northern Ireland Cohort Study"],"prefix":"10.1111","author":[{"given":"Dillon O.","family":"Flynn","sequence":"first","affiliation":[{"name":"Regional Centre for Endocrinology and Diabetes Royal Victoria Hospital Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Kennedy","sequence":"additional","affiliation":[{"name":"Department of Neurology Royal Victoria Hospital Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Neurology Royal Victoria Hospital Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Magill","sequence":"additional","affiliation":[{"name":"Department of Neurology Royal Victoria Hospital Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gavin V.","family":"mc Donnell","sequence":"additional","affiliation":[{"name":"Department of Neurology Royal Victoria Hospital Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Black","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Altnagelvin Hospital, Derry\/Londonderry Northern Ireland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milad","family":"Darrat","sequence":"additional","affiliation":[{"name":"Regional Centre for Endocrinology and Diabetes Royal Victoria Hospital Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8760-4820","authenticated-orcid":false,"given":"Ger","family":"Mullan","sequence":"additional","affiliation":[{"name":"Department of Neurology Royal Victoria Hospital Belfast UK"},{"name":"Wellcome\u2010Wolfson Institute for Experimental Medicine Queen's University Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Darcy","sequence":"additional","affiliation":[{"name":"Regional Centre for Endocrinology and Diabetes Royal Victoria Hospital Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"McCance","sequence":"additional","affiliation":[{"name":"Regional Centre for Endocrinology and Diabetes Royal Victoria Hospital Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsty","family":"Spence","sequence":"additional","affiliation":[{"name":"Endocrine Laboratory Royal Victoria Hospital Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1155-1863","authenticated-orcid":false,"given":"Philip C.","family":"Johnston","sequence":"additional","affiliation":[{"name":"Regional Centre for Endocrinology and Diabetes Royal Victoria Hospital Belfast UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_8_2_1","first-page":"1781","article-title":"Alemtuzumab Improves Outcomes of Relapsing\u2010Remitting Multiple Sclerosis over 3 Years: Results From the CAMMS223 Trial","volume":"359","author":"Compston A.","year":"2008","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1016\/S0140-6736(12)61769-3","article-title":"Alemtuzumab Versus Interferon Beta 1a as First\u2010Line Treatment for Patients With Relapsing\u2010Remitting Multiple Sclerosis: A Randomised Controlled Phase 3 Trial","volume":"380","author":"Cohen J. A.","year":"2012","journal-title":"Lancet"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1016\/S0140-6736(12)61768-1","article-title":"Alemtuzumab for Patients With Relapsing Multiple Sclerosis after Disease\u2010Modifying Therapy: A Randomised Controlled Phase 3 Trial","volume":"380","author":"Coles A. J.","year":"2012","journal-title":"Lancet"},{"key":"e_1_2_8_5_1","first-page":"100","article-title":"Long\u2010Term Follow\u2010up of Patients Treated With Alemtuzumab in CARE\u2010MS Extension Studies: 6\u2010year Outcomes","volume":"89","author":"Coles A. J.","year":"2017","journal-title":"Neurology"},{"issue":"10","key":"e_1_2_8_6_1","article-title":"Thyroid Autoimmune Adverse Events in Patients Treated With Alemtuzumab for Relapsing\u2010Remitting Multiple Sclerosis: Four\u2010Year Follow\u2010up of the CARE\u2010MS Studies (P2.199)","volume":"82","author":"Twyman C.","year":"2014","journal-title":"Neurology"},{"key":"e_1_2_8_7_1","unstructured":"Summary of product characteristics (SPC) for Lemtradahttps:\/\/www.medicines.org.uk\/emc\/product\/5409\/smpc accessed December 12 2025."},{"key":"e_1_2_8_8_1","first-page":"123","article-title":"Immune Reconstitution and Thyroid Autoimmunity After Alemtuzumab","volume":"9","author":"Dayan C. M.","year":"2020","journal-title":"European Thyroid Journal"},{"issue":"4","key":"e_1_2_8_9_1","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1159\/000500881","article-title":"2019 European Thyroid Association Guidelines on the Management of Thyroid Dysfunction Following Immune Reconstitution Therapy","volume":"8","author":"Muller I.","year":"2019","journal-title":"European Thyroid Journal"},{"key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1136\/jnnp-2014-308153","article-title":"Modelling the Natural History of Huntington's Disease Progression","volume":"86","author":"Kuan W. L.","year":"2015","journal-title":"Journal of Neurology, Neurosurgery & Psychiatry"},{"key":"e_1_2_8_11_1","first-page":"1232","article-title":"Real\u2010World Outcomes of Thyroid Dysfunction After Alemtuzumab in European Multiple Sclerosis Centers","volume":"267","author":"Jones J. L.","year":"2020","journal-title":"Journal of Neurology"},{"issue":"2","key":"e_1_2_8_12_1","doi-asserted-by":"crossref","DOI":"10.1177\/2055217320933928","article-title":"Alemtuzumab\u2010Related Thyroid Disease in People With Multiple Sclerosis Is Associated With Age and Brainstem Phenotype at Disease Onset","volume":"6","author":"Yap S. M.","year":"2020","journal-title":"Multiple Sclerosis Journal\u2013Experimental, Translational and Clinical"},{"key":"e_1_2_8_13_1","doi-asserted-by":"crossref","DOI":"10.1136\/jnnp-2020-325504","article-title":"RFC1CANVAS: The Expanding Phenotype","volume":"92","author":"Reilly M. M.","year":"2021","journal-title":"Journal of Neurology, Neurosurgery & Psychiatry"},{"key":"e_1_2_8_14_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.msard.2024.105880","article-title":"Alemtuzumab\u2010Induced Thyroid Disease: A Danish Cohort Study","volume":"91","author":"Hansen J. F.","year":"2024","journal-title":"Multiple Sclerosis and Related Disorders"},{"key":"e_1_2_8_15_1","first-page":"223","article-title":"Immune Reconstitution and Autoimmunity After Alemtuzumab Therapy in Multiple Sclerosis","volume":"139","author":"Jones J. L.","year":"2016","journal-title":"Brain"},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1210\/jc.2013-2201","article-title":"Alemtuzumab\u2010Related Thyroid Dysfunction in a Phase 2 Trial of Patients With Relapsing\u2010Remitting Multiple Sclerosis","volume":"99","author":"Daniels G. H.","year":"2014","journal-title":"Journal of Clinical Endocrinology & Metabolism"},{"key":"e_1_2_8_17_1","first-page":"1020","article-title":"Thyroid Autoimmunity in Alemtuzumab\u2010Treated Multiple Sclerosis Patients: Australian Cohort Study","volume":"26","author":"Malpas C. B.","year":"2020","journal-title":"Multiple Sclerosis Journal"},{"key":"e_1_2_8_18_1","first-page":"1","article-title":"Incidence and Management of Autoimmune Thyroid Disease in Alemtuzumab\u2010Treated MS: A European Multicenter Study","volume":"14","author":"Devonshire V.","year":"2021","journal-title":"Therapeutic Advances in Neurological Disorders"}],"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.70201","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/cen.70201","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.70201","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T09:22:12Z","timestamp":1786612932000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cen.70201"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":17,"alternative-id":["10.1111\/cen.70201"],"URL":"https:\/\/doi.org\/10.1111\/cen.70201","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"value":"0300-0664","type":"print"},{"value":"1365-2265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"assertion":[{"value":"2026-03-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-03","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"cen.70201"}}