{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T21:35:00Z","timestamp":1769722500219,"version":"3.49.0"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Thyroid Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three patients had latent TB and received isoniazid\u2009\u00b1\u2009rifampicin 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\u2019 Ophthalmopathy Quality of Life (GO-QOL) scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13044-025-00283-2","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T10:26:24Z","timestamp":1769682384000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multidisciplinary management of thyroid eye disease (TED) in patients with latent tuberculosis or chronic hepatitis B"],"prefix":"10.1186","volume":"19","author":[{"given":"John S.","family":"Vekinis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vickie","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Aziz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajni","family":"Jain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claire","family":"Feeney","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vassiliki","family":"Bravis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"issue":"4","key":"283_CR1","doi-asserted-by":"publisher","first-page":"G43","DOI":"10.1530\/EJE-21-0479","volume":"185","author":"L Bartalena","year":"2021","unstructured":"Bartalena L, Kahaly GJ, Baldeschi L, et al. The 2021 European group on graves\u2019 orbitopathy (EUGOGO) clinical practice guidelines for the medical management of graves\u2019 orbitopathy. Eur J Endocrinol. 2021;185(4):G43\u201367. https:\/\/doi.org\/10.1530\/EJE-21-0479.","journal-title":"Eur J Endocrinol"},{"key":"283_CR2","doi-asserted-by":"publisher","unstructured":"Hoofnagle JH. Reactivation of hepatitis B. Hepatology. 2009;49(SUPPL 5). https:\/\/doi.org\/10.1002\/HEP.22945.","DOI":"10.1002\/HEP.22945"},{"issue":"1","key":"283_CR3","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1002\/ART.21705","volume":"55","author":"SS Jick","year":"2006","unstructured":"Jick SS, Lieberman ES, Rahman MU, Choi HK. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Care Res (Hoboken). 2006;55(1):19\u201326. https:\/\/doi.org\/10.1002\/ART.21705.","journal-title":"Arthritis Care Res (Hoboken)"},{"issue":"Suppl 2","key":"283_CR4","doi-asserted-by":"publisher","first-page":"ii1","DOI":"10.1136\/thoraxjnl-2017-210927","volume":"72","author":"CS Haworth","year":"2017","unstructured":"Haworth CS, Banks J, Capstick T, et al. British thoracic society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017;72(Suppl 2):ii1\u201364. https:\/\/doi.org\/10.1136\/thoraxjnl-2017-210927.","journal-title":"Thorax"},{"key":"283_CR5","unstructured":"Center for Disease Control and Prevention. Latent Tuberculosis Infection: a guide for primary health care providers."},{"key":"283_CR6","doi-asserted-by":"publisher","unstructured":"Mourits MP, Prummel MF, Wiersinga WM, Koornneef L. Clinical activity score as a guide in the management of patients with Graves\u2019 ophthalmopathy. Clin Endocrinol (Oxf). 1997;47(1). https:\/\/doi.org\/10.1046\/j.1365-2265.1997.2331047.x.","DOI":"10.1046\/j.1365-2265.1997.2331047.x"},{"key":"283_CR7","doi-asserted-by":"publisher","unstructured":"Bahn RS, Gorman CA. Choice of therapy and criteria for assessing treatment outcome in thyroid-associated ophthalmopathy. Endocrinol Metab Clin North Am. 1987;16(2). https:\/\/doi.org\/10.1016\/s0889-8529(18)30485-7.","DOI":"10.1016\/s0889-8529(18)30485-7"},{"key":"283_CR8","doi-asserted-by":"publisher","unstructured":"Terwee CB, Gerding MN, Dekker FW, Prummel MF, Wiersinga WM. Development of a disease specific quality of life questionnaire for patients with Graves\u2019 ophthalmopathy: the GO-QOL. Br J Ophthalmol. 1998;82(7). https:\/\/doi.org\/10.1136\/bjo.82.7.773.","DOI":"10.1136\/bjo.82.7.773"},{"issue":"8","key":"283_CR9","doi-asserted-by":"publisher","first-page":"936","DOI":"10.5588\/IJTLD.15.0031","volume":"19","author":"CC Lai","year":"2015","unstructured":"Lai CC, Lee MTG, Lee SH, Lee SH, Chang SS, Lee CC. Risk of incident active tuberculosis and use of corticosteroids. Int J Tuberculosis Lung Disease. 2015;19(8):936\u201342. https:\/\/doi.org\/10.5588\/IJTLD.15.0031.","journal-title":"Int J Tuberculosis Lung Disease"},{"issue":"10","key":"283_CR10","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1136\/THX.2005.046797","volume":"60","author":"LP Ormerod","year":"2005","unstructured":"Ormerod LP, Milburn HJ, Gillespie S, Ledingham J, Rampton D. BTS recommendations for assessing risk and for managing Mycobacterium tuberculosis infection and disease in patients due to start anti-TNF-\u03b1 treatment. 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BMC Gastroenterol. 2022;22(1):1\u20136. https:\/\/doi.org\/10.1186\/S12876-022-02133-Z\/TABLES\/2.","journal-title":"BMC Gastroenterol"}],"container-title":["Thyroid Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13044-025-00283-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13044-025-00283-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13044-025-00283-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T10:26:27Z","timestamp":1769682387000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s13044-025-00283-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["283"],"URL":"https:\/\/doi.org\/10.1186\/s13044-025-00283-2","relation":{},"ISSN":["1756-6614"],"issn-type":[{"value":"1756-6614","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"assertion":[{"value":"17 August 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This retrospective audit was registered and approved by Imperial College Healthcare National Health Service (NHS) Trust, London. Data were anonymised and confidentiality was maintained throughout. This audit adhered to the tenets of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Miss Vickie Lee is: Principal Investigator for the Horizon, Viridian, Argenx, LIDS and Lassen Trials. British Oculoplastic Surgery Society (BOPSS) National Lead for Thyroid Eye Disease. Advisory board and consulting for Amgen, Viridian, Argenx and Roche Pharmaceuticals. Honoraria from Amgen.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"6"}}