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PubMed This is a summary of 19 peer-reviewed journal articles Updated
Endocrinology · Thyroid Eye Disease

Modern Advances in Treating Thyroid Eye Disease

At a Glance

Teprotumumab (Tepezza) is a breakthrough FDA-approved treatment for Thyroid Eye Disease that effectively reduces eye bulging and double vision by targeting the disease's underlying biology. However, patients require careful hearing monitoring due to the risk of permanent hearing loss.

For decades, the treatment for Thyroid Eye Disease (TED) was limited to managing symptoms with lubricants or using high-dose steroids to quiet inflammation. If the eyes bulged significantly, the only solution was often major surgery [1]. However, the landscape changed recently with the introduction of Teprotumumab (Tepezza), the first FDA-approved medication to target the biological roots of the disease rather than just its symptoms [2].

A New Standard of Care

Moderate-to-severe TED is now increasingly treated with Teprotumumab, a monoclonal antibody that acts as an IGF-1R inhibitor [3].

In Graves’ disease, there is a “crosstalk” between the thyroid receptors and the receptors behind your eyes (IGF-1R) [4]. Teprotumumab blocks this signal, which effectively shuts down the inflammation and prevents the tissues behind the eye from expanding [2].

  • Proptosis Reduction: Unlike older treatments, Teprotumumab has shown a significant ability to reduce proptosis (eye bulging), often by 2 millimeters or more [5].
  • Double Vision: It is also highly effective at improving diplopia (double vision) by reducing the swelling of the muscles that move the eye [6][7].
  • Avoiding Surgery: Because it can physically shrink the tissue behind the eye, many patients who take Teprotumumab are able to avoid or delay orbital decompression surgery [8].

Understanding the Risks: Hearing Loss

While Teprotumumab is a breakthrough, it carries a unique and significant side effect: ototoxicity, or damage to the hearing system [9].

  • Frequency and Nature: A significant number of patients report audiologic issues, including tinnitus (ringing in the ears), a feeling of “fullness,” or sensorineural hearing loss [10][11].
  • Permanence: While some patients see their hearing return after stopping the drug, others have experienced persistent or irreversible hearing loss [12][13].
  • Monitoring: Most specialists now recommend an audiogram (a professional hearing test) before starting treatment and regular check-ups with an ear, nose, and throat (ENT) doctor during the course of therapy [14][15].

Traditional and Surgical Options

Teprotumumab has not completely replaced older methods, which are still used depending on the patient’s needs:

  • Corticosteroids: Intravenous (IV) steroids remain a common way to quickly reduce intense “active” inflammation, though they are less effective at reducing bulging than newer drugs [1][5].
  • Orbital Decompression: This surgery involves removing a small amount of bone or fat from the eye socket to create more room for the eye to sit back naturally [8]. It is generally reserved for stable (inactive) disease or when medical treatments aren’t enough [16].

The Non-Negotiable: Smoking Cessation

Regardless of which treatment you choose, stopping smoking is the most critical action you can take [17]. Smoking makes every form of TED treatment less effective and significantly increases the chance that your eye disease will progress to a stage requiring surgery [18][17]. Quitting smoking effectively lowers the overall “burden” of the disease on your body [19].

Common questions in this guide

How does Tepezza help with Thyroid Eye Disease?
Tepezza (Teprotumumab) is a medication that blocks the specific biological signals causing inflammation behind the eyes. It is highly effective at reducing eye bulging and improving double vision in patients with moderate-to-severe TED.
What are the main side effects of Tepezza?
The most significant risk of Tepezza is hearing damage, such as ringing in the ears, a feeling of fullness, or hearing loss. Because this side effect can sometimes be permanent, doctors usually require hearing tests before and during treatment.
Will I still need surgery if I take medication for Thyroid Eye Disease?
Many patients who take modern medications like Teprotumumab are able to avoid or delay orbital decompression surgery. However, surgery may still be necessary if the disease becomes inactive but leaves you with significant eye bulging that medication cannot fully resolve.
How does smoking affect Thyroid Eye Disease?
Smoking makes all forms of treatment for Thyroid Eye Disease less effective and significantly increases the risk that your condition will progress and require surgery. Quitting smoking is the most important step you can take to give your eyes the best chance of recovery.
Are steroid treatments still used for eye bulging?
Intravenous steroids are still used to quickly reduce active, intense inflammation in the eyes. However, steroids are generally less effective at reducing actual eye bulging compared to newer targeted therapies like Teprotumumab.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given the severity of my eye bulging and double vision, would you recommend Teprotumumab as a first-line treatment over steroids?
  2. 2.What is your protocol for monitoring my hearing during treatment, and at what point would we stop the medication if my hearing changes?
  3. 3.If I choose Teprotumumab, what is the likelihood that I will still need orbital decompression surgery later?
  4. 4.Are there specific side effects besides hearing loss, such as changes in my blood sugar or muscle cramps, that I should watch for?
  5. 5.How will we coordinate my care between you (my endocrinologist), an ophthalmologist, and an audiologist?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (19)
  1. 1

    Teprotumumab Treatment for Thyroid-Associated Ophthalmopathy.

    Smith TJ

    European thyroid journal 2020; (9(Suppl 1)):31-39 doi:10.1159/000507992.

    PMID: 33511083
  2. 2

    Thyroid eye disease (Graves' orbitopathy): clinical presentation, epidemiology, pathogenesis, and management.

    Wiersinga WM, Eckstein AK, Žarković M

    The lancet. Diabetes & endocrinology 2025; (13(7)):600-614 doi:10.1016/S2213-8587(25)00066-X.

    PMID: 40324443
  3. 3

    Advances of IGF-1R inhibitors in Graves' ophthalmopathy.

    Wang M, Liu L

    International ophthalmology 2024; (44(1)):435 doi:10.1007/s10792-024-03358-5.

    PMID: 39578269
  4. 4

    The therapeutic revolution in thyroid eye disease: from orbital radiotherapy to teprotumumab and AI.

    Yuan X, Li H, Wang F

    Frontiers in medicine 2026; (13()):1758015 doi:10.3389/fmed.2026.1758015.

    PMID: 41728592
  5. 5

    Redefining evidence for teprotumumab in thyroid eye disease: an updated meta-analysis of efficacy and safety.

    Song R, Zhao W, Li S, et al.

    Frontiers in endocrinology 2026; (17()):1735660 doi:10.3389/fendo.2026.1735660.

    PMID: 41767371
  6. 6

    Teprotumumab for thyroid eye disease in patients with hypothyroid/euthyroid state: a multicenter case series.

    Ugradar S, Parunakian E, Malkhasyan E, et al.

    Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie 2025; (263(1)):225-230 doi:10.1007/s00417-024-06599-3.

    PMID: 39136754
  7. 7

    Teprotumumab for the Treatment of Recalcitrant Thyroid Eye Disease.

    Men CJ, Amarikwa L, Pham B, et al.

    Ophthalmic plastic and reconstructive surgery 2024; (40(3)):276-285 doi:10.1097/IOP.0000000000002564.

    PMID: 37972960
  8. 8

    Orbital decompression following treatment with teprotumumab for thyroid eye disease.

    Topilow NJ, Penteado RC, Ting M, et al.

    Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 2025; (60(1)):e59-e64 doi:10.1016/j.jcjo.2024.06.003.

    PMID: 39059786
  9. 9

    Risk of audiologic side effects with teprotumumab treatment for thyroid eye disease: propensity matched analysis.

    Markle JC, Johanis A, Shaia JK, et al.

    Eye (London, England) 2025; (39(6)):1107-1114 doi:10.1038/s41433-024-03531-1.

    PMID: 39668181
  10. 10

    Teprotumumab and sensorineural hearing loss: a propensity score-matched retrospective cohort study.

    Barnett MJL, Lam J, Jara-Tantoco MN, et al.

    Endocrine connections 2025; (14(7)).

    PMID: 40680730
  11. 11

    Otologic Symptoms Following Teprotumumab Administration in Patients with Thyroid Eye Disease.

    Epperson MV, Hughes S, Valenzuela CV, Stucken EZ

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2025; (46(3)):330-335 doi:10.1097/MAO.0000000000004418.

    PMID: 39951668
  12. 12

    Ototoxicity and Teprotumumab.

    Highland J, Gordon S, Reddy D, Patel N

    The Annals of otology, rhinology, and laryngology 2022; (131(8)):910-913 doi:10.1177/00034894211042740.

    PMID: 34448414
  13. 13

    Persistent Palmar Rash Associated with Teprotumumab Treatment.

    He LR, Villatoro GA, Yen MT

    Ophthalmic plastic and reconstructive surgery 2026; (42(1)):e8-e9 doi:10.1097/IOP.0000000000002985.

    PMID: 40488249
  14. 14

    A Biologic With Otologic Consequences: Analysis of Hearing Loss and Teprotumumab Using the FDA Adverse Event Reporting System.

    Huynh PP, Saba E, Rivero A, et al.

    Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2024; (45(8)):e566-e569 doi:10.1097/MAO.0000000000004260.

    PMID: 39142306
  15. 15

    Thyroid Eye Disease, Teprotumumab, and Hearing Loss: An Evolving Role for Otolaryngologists.

    Chern A, Dagi Glass LR, Gudis DA

    Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2021; (165(6)):757-758 doi:10.1177/01945998211004240.

    PMID: 33781112
  16. 16

    Teprotumumab and Orbital Decompression for the Management of Proptosis in Patients With Thyroid Eye Disease.

    Hubschman S, Sojitra B, Ghiam S, et al.

    Ophthalmic plastic and reconstructive surgery 2024; (40(3)):270-275 doi:10.1097/IOP.0000000000002563.

    PMID: 37972968
  17. 17

    Smoking Is Associated With a Higher Risk of Surgical Intervention for Thyroid Eye Disease in the IRIS Registry.

    Oke I, Reshef ER, Elze T, et al.

    American journal of ophthalmology 2023; (249()):174-182 doi:10.1016/j.ajo.2023.01.020.

    PMID: 36690290
  18. 18

    Ocular conditions and dry eye due to traditional and new forms of smoking: A review.

    Makrynioti D, Zagoriti Z, Koutsojannis C, et al.

    Contact lens & anterior eye : the journal of the British Contact Lens Association 2020; (43(3)):277-284 doi:10.1016/j.clae.2020.02.009.

    PMID: 32111452
  19. 19

    Mitigating the risks: addressing smoking cessation in thyroid eye disease.

    Karimi N, Kashkouli MB, Keyhani A, et al.

    BMJ open ophthalmology 2025; (10(1)) doi:10.1136/bmjophth-2025-002226.

    PMID: 40889896

This page provides educational information about Thyroid Eye Disease treatments, including Tepezza and surgery. It is not a substitute for professional medical advice from your endocrinologist or ophthalmologist.

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