How Is Thyroid Eye Disease Treated?
Reviewed by: HU Medical Review Board | Last reviewed: October 2021
Thyroid eye disease (TED) is a progressive condition. This means that it gets worse over time. There are 2 phases of TED: an active phase and an inactive phase. Each phase is different. Treatment goals for each phase are also different.1
The goal of treatment in the active phase is to reduce inflammation. Treatment goals in the inactive phase focus on repairing damage of tissue.1,2
It is possible for TED to “flare” after the inactive phase, causing active symptoms to reappear. TED is a rare condition and can cause serious vision issues if left untreated.1
Seeing a TED specialist is important. TED specialists are eye doctors who specialize in diagnosing and treating the disease. These doctors will recommend the best treatment for you, depending on your symptoms and history.2
The treatments most commonly used for the different phases of TED include:1,3
- Steroids
- Monoclonal antibody drugs
- Botox
- Radiotherapy
- Surgery
- Supportive treatments
Steroids
Steroids (corticosteroids) are strong anti-inflammatory drugs. When given in doses higher in amount than your body normally makes, steroids quickly decrease inflammation.3,4
People with TED are often started on a high dose of steroids that is then gradually lowered over time. This tapering of steroids is important to decrease the chance of negative long-term side effects from this therapy.3
Monoclonal antibody drugs
Antibodies are proteins the body’s immune system makes to kill germs. In autoimmune diseases like TED, the body makes harmful antibodies. These harmful antibodies cannot tell the difference between healthy cells and invaders like bacteria, viruses, and fungi.1
Insulin-like growth factor 1 receptor (IGF-1R) is a protein that is connected to thyroid hormones. Too much thyroid hormone “turns on” IGF-1R. This leads to growth of muscle, fat, and connective tissue cells around the eyes. Too much growth of these cells causes the symptoms of TED.5
A new type of drug blocks the IGF-1R receptor, which can decrease symptoms in TED. This drug is known as a monoclonal antibody or antibody immunotherapy. It works by acting like proteins made by your immune system. Monoclonal antibodies belong to a class of drugs known as biologic disease-modifying drugs (DMDs).3
As of 2021, there is only 1 IGF-1R inhibitor approved by the U.S. Food and Drug Administration (FDA) to treat TED:3
- TepezzaⓇ(teprotumumab)
Botox
BotoxⓇ (onabotulinumtoxin A) is an injectable drug used to treat eye misalignment in TED (strabismus, struh-biz-mis). Botox is a well-studied neurotoxin. Talk to your doctor about this treatment to learn more about the risks and benefits of this drug.3
Radiotherapy
Orbital radiotherapy (ORT) is used to treat TED. This therapy uses beams of energy (radiation) that is pointed to a targeted area behind the eye.3
ORT can be slower to show symptom improvement of TED when compared to the rapid improvement of symptoms with steroids. However, ORT may be a better option for those who cannot tolerate steroid therapy. ORT may also be used with steroid therapy to help decrease the need for large doses of steroids.3,6
Surgery
Surgery is sometimes used to correct the damage that TED can cause, such as scarring to the muscles and tissues around the eye. Surgery is not performed in the acute phase because inflammation and damage may still occur.3
Once TED reaches the chronic phase, your TED specialist will decide if surgery is needed. Multiple surgeries are usually needed to correct the damage caused by TED. The procedures are usually done in a specific order:3
- Orbital decompression, which is used to relieve proptosis (prop-toe-sis) or bulging eyes.
- Double vision (strabismus) surgery, which moves the muscles around your eye to get your eyes to point in the same direction again.
- Eyelid repair (retraction) surgery, which releases the tight connective tissue and muscles around your eyelid. This allows your eyelids to return to their natural shape and position.
Supportive treatment
Supportive treatments for eye lubrication, pain, and discomfort are also commonly used in the acute phase. These include home remedies like warm compresses, as well as diet and supplements. Talk to your doctor before starting a new regimen, diet, or supplement.2,3
