Teprotumumab for thyroid eye disease-associated superior ophthalmic vein periphlebitis: a case series.

PURPOSE: To evaluate the clinical and radiologic response of thyroid eye disease (TED)-associated superior ophthalmic vein periphlebitis (SOVP) to teprotumumab treatment. METHODS: A retrospective chart review was performed at three institutions until June 2026. Patients with active moderate-to-severe TED with concomitant extraocular muscle (EOM) inflammation who underwent orbital magnetic resonance imaging (MRI) before teprotumumab initiation and after the 4th and 8th infusion were included. SOVP was defined as high signal intensity of the SOV wall on short tau inversion recovery (STIR) MRI. Demographic, clinical, and radiologic data were analyzed. Changes in Clinical Activity Score (CAS), Hertel exophthalmometric measurements, logMAR visual acuity, and SOV diameter were compared before and after treatment. RESULTS: Among 131 patients treated with teprotumumab, 7 patients (5.3%; 4 men and 3 women) demonstrated unilateral SOVP. Inflammation of the superior rectus/levator palpebrae superioris complex was observed in 6 of 7 patients. Following treatment, CAS decreased significantly from 3.6 to 0.3 (P = 0.017), and Hertel measurements decreased from 20.1 mm to 17.7 mm (P = 0.027). LogMAR visual acuity showed no significant change (- 0.07 vs. -0.09; P = 0.317). STIR MRI demonstrated complete resolution of SOV wall hyperintensity in all patients, accompanied by complete resolution of EOM inflammation. The mean vertical SOV diameter decreased significantly from 3.99 mm to 2.21 mm (P = 0.018). CONCLUSIONS: All patients with TED-associated SOVP demonstrated complete radiologic resolution, with significant reduction in SOV diameter and improvement in disease activity and proptosis, supporting SOVP as a reversible inflammatory manifestation of active TED.