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The goal of treating thyroid eye disease (TED) is to reduce your symptoms and prevent vision loss. TED is an autoimmune disease that can cause eye irritation, pain, vision changes, and changes to your eyes’ appearance. In an autoimmune disease, the body’s immune system mistakenly attacks its own tissues, leading to various health problems depending on which tissues are targeted.
Your treatment for TED will likely involve a team of health care professionals, including ophthalmologists (who specialize in eye disorders), endocrinologists (who focus on hormone-related conditions), and other specialists. Your treatment may involve medication, surgery, or lifestyle changes.
TED can affect everyone differently, so the best treatment for you will consider your personal needs, symptoms, and medical history.
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 is a type of biologic called a monoclonal antibody. A biologic is a type of medication made from substances that come from living organisms. A monoclonal antibody is a protein that’s made in a laboratory that helps to regulate your immune system. Teprotumumab-trbw targets insulin-like growth factor receptor (IGF-R) — a protein involved in activating inflammatory cells around the eye. By blocking IGF-R, teprotumumab-trbw can help decrease inflammation and prevent the fat and muscle behind your eye from expanding.
A health care provider will give you this medication in a hospital. You receive teprotumumab-trbw as an injection into your vein — also called an intravenous (IV) infusion — every three weeks for a total of eight treatments.
The most common side effects of teprotumumab-trbw include:
Corticosteroids are anti-inflammatory drugs that can help decrease the activity of your immune system. By reducing inflammation, the pain, swelling, and redness due to TED can improve. However, corticosteroids generally don’t help to improve certain TED symptoms like bulging eyes or double vision.
Examples of common corticosteroids include prednisone and methylprednisolone. You can take corticosteroids by mouth or as an IV infusion. You can also get corticosteroids as an injection directly into your eye or in the tissue surrounding your eye.
Corticosteroids are usually only taken for a short time due to the potential for side effects, such as:
Corticosteroids are also associated with side effects that affect the eyes, such as cataracts (clouding of the lens of your eye) and glaucoma (increased pressure in your eye).
Immunosuppressants are medications that block your immune system from attacking your healthy tissue. Immunosuppressants can help reduce inflammation in the tissues around your eye. Sometimes, these immunosuppressants are taken in combination with a corticosteroid. Examples of immunosuppressants that may be used to treat TED include:
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.
Lubricating eye drops can help relieve symptoms caused by dry, irritated eyes. These drops add moisture and can provide immediate relief, making your eyes feel more comfortable throughout the day.
Your health care provider may recommend that you use artificial tears during the day. At night, eye gels or ointments may work better.
There are many options for lubricating eye drops, and many are available without a prescription. Talk to your health care provider about which lubricating eye drops may be best for you.
Artificial tears help maintain a tear film on the surface of your eyes to prevent them from drying out. You can use most types of artificial tears as often as you need to — even every 30 to 60 minutes — if needed.
If you’re using eye drops more than four times per day, it’s recommended to use preservative-free eye drops. Using eye drops that contain preservatives may cause more eye irritation in some people.
Even though your eyes may be red due to irritation, it’s important that the eye drops you choose don’t have ingredients for reducing redness, as they can make irritation worse. Instead, choose drops that help keep your eyes moist and comfortable.
Eye gels and ointments are thicker formulations designed to stay in your eye for a longer period of time. If your eyelids don’t close all the way, these thicker formulations may work better for you at night while you sleep.
Gels and ointments can make your vision blurry for some time after you put them in your eye. For this reason, it’s best not to use these thicker formulations during the day when you need to see clearly.
Selenium is an essential mineral that helps your thyroid work properly and may improve symptoms related to inflammation. Taking a selenium supplement is beneficial for people with mild TED. Clinical trials are needed to prove the benefit for people with moderate to severe TED.
Selenium supplements are often recommended for six months. However, the benefits of selenium can continue for six months after you stop.
If you get too much selenium, you may experience side effects, such as:
Restoring normal thyroid function is an important part of TED treatment. When your thyroid is working properly, it helps regulate your metabolism (how your body turns food into energy).
TED is most commonly associated with Graves’ disease, a condition that often causes high levels of thyroid hormones (hyperthyroidism). Treatments for hyperthyroidism may include:
TED is also associated with low levels of thyroid hormones (hypothyroidism). If you have hypothyroidism, treatment usually includes taking thyroid replacement medications.
Although restoring your normal thyroid function is an important part of your TED treatment plan, it’s important to know that treating thyroid problems probably won’t resolve TED symptoms.
Surgery may be a treatment option when TED is stable. Surgery can help improve certain cosmetic concerns, as well as improve some symptoms.
Surgical options for TED include:
Orbital radiotherapy involves using beams of intense energy to reduce inflammation around the eye. This treatment is usually combined with corticosteroids. You may undergo orbital radiotherapy early during the active phase of inflammation in moderate to severe TED.
If you have double vision, your health care provider may prescribe glasses with prisms. A prism helps bend light before it reaches your eye so it’s redirected to the correct place on the retina of each eye. Prisms may not work for everyone. If a prism doesn’t work for you, an eye patch or eye muscle surgery can help manage double vision.
Dark sunglasses are another type of glasses that may help if you experience light sensitivity. They can also protect your eyes from harmful ultraviolet rays and reduce strain by cutting down on glare, making outdoor activities more comfortable.
There are several changes you can make in your daily habits that may help improve TED symptoms.
If you smoke, you may be increasing your risk of TED and making your condition harder to treat. Options to help you quit smoking include:
If your eyelids don’t completely close while you sleep, taping your eyelids may help prevent dry eyes. Make sure to use a gentle, hypoallergenic tape specifically designed for the skin to avoid irritation.
Keeping your head higher than your body when you lie down can help relieve pressure on your eyes and reduce eyelid swelling. You can try propping up the head of your bed or using extra pillows.
Applying a cool compress to your eyes can help relieve symptoms related to dry eye and swelling. The compress can soothe irritation, reduce redness, and provide immediate comfort to the affected area.
Clinical trials for TED are research studies that can help find new treatments. There are several ongoing clinical trials for new TED treatments. Talk to your health care provider to find out if you qualify for any clinical trials.
On TEDhealthteam, the social network for people living with TED and their loved ones, members come together to ask questions, give advice, and share their stories with those who understand life with TED.
Are you or a family member living with TED? What treatments have best helped you manage your condition? Share your experience in the comments below, or start a conversation by posting on your Activities page.
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Christopher L. Haupert, M.D.
has 24 years of experience as a vitreoretinal surgeon with Iowa Retina Consultants.
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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