The Connection Between Hearing Loss and Tepezza® in Thyroid Eye Disease

Thyroid eye disease (TED) is a rare autoimmune disease that damages tissues around the eyes. An autoimmune disease is a disease that is caused by the body mistakenly attacking itself. TED can cause red, dry, irritated eyes and trouble seeing.^1,2

In 2020, the US Food and Drug Administration (FDA) approved the first drug specifically for TED. It is called Tepezza® (teprotumumab-trbw). But some people have reported concerning side effects from Tepezza, like hearing loss.²

What is Tepezza?

Tepezza is the first and only drug approved specifically for TED. It works by targeting the process that causes the eye tissue to swell. This lessens the swelling and improves TED symptoms. Tepezza has been shown to reduce eye bulging, double vision, eye pain, and eye redness. Tepezza is given through infusions, in which the drug is given directly into the veins.^1,2

Tepezza was approved based on the results of 2 clinical studies. People in these studies received 8 infusions of either Tepezza or an inactive substance (placebo). Around 75 percent of the people who received Tepezza in both studies had improvements in TED symptoms.^2,3

These studies also found Tepezza may cause the following side effects:^2,3

• Hearing loss
• Muscle spasms
• Nausea
• Hair loss
• Diarrhea
• Fatigue
• High blood sugar
• Dry skin
• Headache
• Taste changes
• Weight loss
• Nail problems

Does Tepezza cause hearing loss?

In the first clinical studies on Tepezza, about 10 percent of people in the studies reported hearing loss. After they stopped Tepezza, their hearing was restored. Later, other studies also looked at the link between hearing loss and Tepezza.^2,3

An independent study looked at 28 people who had at least 4 Tepezza infusions. This study found that about 50 percent of these people had hearing-related symptoms. These symptoms included:^4,5

• Hearing loss
• Ringing in the ears
• A feeling like the ears are plugged
• Hearing their own voice unusually loud
• Damaged hair cells in the inner ear
• A condition where the tubes between the ear and throat stay open (patulous eustachian tube)

In this study, these hearing-related symptoms started after about 3 Tepezza infusions. Also, not everyone’s hearing-related symptoms improved after the study. After the 3-month follow-up, 3 people still had hearing-related symptoms. For those with symptom improvement, their hearing-related symptoms took between 1 and 6 months to improve.^4,5

Because of this, these researchers recommended that people who start Tepezza should have an initial hearing test. This will help track any changes in hearing after starting Tepezza.^4,5

This was a very small study, and it does not fully explain the effect of Tepezza on hearing. We still do not know how reversible the Tepezza side effects are. More research is needed to understand the link between Tepezza and hearing loss.^4,5

Other treatments for thyroid eye disease

The link between Tepezza and hearing loss has not been fully proven or understood yet. Luckily, there are other ways to treat TED, such as:¹

• Eye drops
• Steroids
• Lifestyle changes such as wearing special glasses, wearing eye patches, or taping your eyes when you sleep
• Quitting smoking
• Surgery to treat TED
• Selenium supplements, which may help some people

If you take Tepezza and are concerned about your hearing, talk with your doctor. They may be able to assess your risk for hearing-related side effects and suggest other treatment options.¹