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Treating your thyroid eye disease (TED) can help decrease your symptoms and prevent loss of vision. TED treatment often involves a team of different health care professionals, including:
Some people may use only over-the-counter (OTC) options, such as lubricating eye drops to treat symptoms like dry eye. If OTC treatments or lifestyle changes aren’t sufficient, your doctor may suggest trying prescription medications.
Below are some of the treatment options your health care team may recommend.
Teprotumumab-trbw (Tepezza) is the first medication approved by the U.S. Food and Drug Administration (FDA) to treat moderate to severe TED. Teprotumumab-trbw can improve TED symptoms, including:
Teprotumumab-tbrw is a type of biologic drug called a monoclonal antibody. A monoclonal antibody is a protein that’s made in a laboratory that regulates your immune system.
Teprotumumab-tbrw targets and blocks a protein called insulin-like growth factor receptor (IGF-R) that is involved in activating inflammatory cells around the eye. When IGF-R is blocked, inflammation is decreased, preventing the fat and muscle behind the eye from expanding.
Teprotumumab-tbrw is given as an intravenous (into a vein) injection. You receive this medication in a hospital or outpatient health care setting.
The most common side effects of teprotumumab include:
Serious side effects can also occur, such as an infusion reaction, worsening of inflammatory bowel disease (IBD), and low blood sugar.
People with moderate to severe TED may take corticosteroids to help decrease inflammation and swelling. Although corticosteroids can help with symptoms related to inflammation, they have not been proven to help to improve TED symptoms in formal clinical trials.
Examples of common corticosteroids used to treat TED include prednisone and methylprednisolone.
Corticosteroids are anti-inflammatory drugs that can help decrease the activity of your immune system. This can help improve pain and swelling associated with TED.
There are many different forms of corticosteroids. You can take corticosteroids by mouth or as an IV infusion. You can also get corticosteroids as an injection directly into the tissue surrounding your eye.
When taking a corticosteroid medication, it’s important to follow your health care provider’s instructions exactly.
Corticosteroids are usually only taken for a short time due to the potential for side effects, such as:
Corticosteroids can also cause side effects that directly affect your eyes, such as cataracts (clouding of the lens of your eye) and glaucoma (increased pressure in your eye).
Tocilizumab (Actemra) is a treatment option for people with moderate to severe TED who don’t respond well to teprotumumab or corticosteroids. Although tocilizumab isn’t FDA approved to treat TED, your health care team may recommend this treatment in certain circumstances.
Like teprotumumab-tbrw, tocilizumab is a monoclonal antibody that regulates your immune system. However, tocilizumab targets a protein called interleukin-6 (IL-6) receptor. Blocking the IL-6 receptor helps reduce inflammation.
Tocilizumab is often given as a monthly IV infusion for at least four months.
The most common side effects of tocilizumab include:
Serious side effects may include hepatitis B infection, serious infections, serious allergic reactions, and nervous system problems.
Teprotumumab-tbrw, corticosteroids, and tocilizumab are all types of immunosuppressants. However, your health care provider may recommend other immunosuppressants to treat TED in some cases.
Examples of other immunosuppressants that may be used to treat TED include:
Immunosuppressants block your immune system from attacking your healthy tissue. They can help reduce inflammation in the tissues around your eye.
Your health care provider will tell you exactly how to take your medication. Some immunosuppressants are taken by mouth, while others are given by an IV infusion. The way you take these medications depends on the type of medicine and what your doctor determines is best for you.
The side effects of immunosuppressants differ based on which medication you’re taking. All immunosuppressants can increase your risk of infection. This is because when your immune system is suppressed, it can’t defend against germs and viruses as well as it should.
If you have mild TED, your health care provider may recommend that you take a selenium supplement. It’s uncertain if selenium supplements are beneficial for people with moderate or severe TED. Selenium isn’t FDA approved to treat TED.
Selenium is an essential mineral that helps your thyroid work properly. Taking selenium may improve symptoms related to inflammation. Additionally, selenium may help prevent mild TED from progressing to a more severe form.
Selenium supplements are usually taken by mouth daily for six months. However, the benefits of selenium can continue for six months after you stop. Talk to your health care provider to find out how you should take selenium.
If you get too much selenium, you may experience side effects, such as:
Restoring normal thyroid function is an important part of TED treatment. Notably, however, treating thyroid problems probably won’t improve TED symptoms.
TED is most commonly associated with Graves’ disease, a condition that often causes hyperthyroidism (high levels of thyroid hormones). Medications for hyperthyroidism block your thyroid from making more thyroid hormone, called antithyroid drugs. Examples of antithyroid drugs include methimazole (Tapazole) and propylthiouracil.
TED is sometimes associated with hypothyroidism (low levels of thyroid hormones). If you have hypothyroidism, treatment usually includes taking thyroid replacement medication called levothyroxine (sold under brand names including Synthroid, Levoxyl, and others).
Thyroid medications help your thyroid to work the way it should. When your thyroid is working properly, it helps to regulate your metabolism (how your body turns food into energy).
Most thyroid treatments are taken by mouth. Your exact directions depend on the type of thyroid medication you’re taking and what your health care provider determines is best for you.
The side effects of thyroid medication depend on which medication you’re taking. Common side effects of antithyroid medications include:
Side effects of levothyroxine may include:
As researchers learn more about how and why people develop TED, they can discover new targets for TED treatment. You may see new medications for TED that block IGF-R, like teprotumumab, that don't need to be given through an IV infusion.
You can help find new treatments for TED by participating in a clinical trial. Talk to your health care provider to find out if you qualify for any clinical trials.
TEDhealthteam is the social network for people with thyroid eye disease and their loved ones. On TEDhealthteam, members come together to ask questions, give advice, and share their stories with others who understand life with thyroid eye disease.
What medications have you taken for TED? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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Paul B. Griggs, M.D.
is certified by the American Board of Ophthalmology.
Learn more about him here.
Amanda Jacot, PharmD
earned a Bachelor of Science in biology from the University of Texas at Austin in 2009 and a Doctor of Pharmacy from the University of Texas College of Pharmacy in 2014.
Learn more about her here.
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I am currently on Synthroid, eye gel and lubricants many times per day. I was diagnosed in 2012 with mild TED. Has been stable until the last year. Had to have cataract surgery in January 2024. Been… read more
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