Thyroid eye disease (TED) is a rare autoimmune disorder that causes damage to the tissues, muscles, and fat surrounding the eye. Though many do not suffer vision loss, some do. Many also have lasting symptoms related to TED, including scarring.1
TED affects everyone differently, and its impact can vary from person to person. This means there is no one-size-fits-all set of drugs to treat TED.
Your doctor’s goals for any drugs prescribed for TED will be to control the symptoms and improve your quality of life, using the lowest doses possible. Because there are separate phases in TED, some people find that their symptoms may disappear in the inactive phase. However, damage may still have occurred from the active phase, and symptoms of TED can reappear.2
Treatment goals for the active phase of TED focus on decreasing inflammation, swelling, and pain. For the inactive phase, treatment is mostly supportive since much of the damage from TED occurs in the active phase.2
Types of drugs used
A variety of drugs are used to treat TED:3
- Steroids, or corticosteroids, are a type of hormone used to quickly control TED symptoms. These drugs are strong anti-inflammatories. Intravenous (IV) prednisone is the steroid most often prescribed. Doctors try to avoid high doses of steroids long-term because these drugs can have many side effects.
- Monoclonal antibodies are drugs that work by acting like proteins made by your immune system. Because a harmful antibody causes TED symptoms, this type of therapy aims at blocking the cause of these symptoms. As of 2021, TepezzaⓇ (teprotumumab) is the only monoclonal antibody therapy approved by the U.S. Food and Drug Administration (FDA) to treat TED. Monoclonal antibodies belong to a class of drugs known as biologic disease-modifying drugs (DMDs).
- Neuromuscular blockers work to block nerve signals between the muscles and brain. There are many different types of this drug, but BotoxⓇ (onabotulinum toxin) is the only one used to treat TED. Botox is an injection that can be used to treat misalignment of your eyes (strabismus, struh-biz-mis).
If you have TED and are trying to get pregnant or are already pregnant, your doctor may need to change or add to some of the drugs you take in order to support a healthy pregnancy. Talk to your doctor about this. Discuss all risks and benefits of treatments.
Your thyroid and its impact on TED
People with thyroid eye disease may or may not have problems with their thyroid gland. This gland, which controls many functions in your body, is primarily responsible for your metabolism.4
Many people with TED have an overactive thyroid (hyperthyroidism). Others may have low thyroid function (hypothyroidism) or normal thyroid function (euthyroid).4
Depending on your thyroid function, your doctor or TED specialist may recommend different drugs to maintain a normal thyroid function. Studies show that keeping your thyroid levels within a normal range may help with the symptoms of TED. However, this is not always true. Your eyes and thyroid function are separate. Conditions that occur together should be treated as distinct diseases, needing different drugs to treat them.4
Drugs are only part of the overall approach to managing thyroid eye disease. Your doctors will also recommend lifestyle changes to control TED. They may also suggest various corrective surgeries and supportive or home remedies that might help.