Non-surgical Treatment

For mild disease, initial management focuses on reducing dry eye and exposure symptoms. Often due to eye bulging, eyelid retraction, or a combination of the two, the eye can experience dryness, redness, and irritation. Initial treatment recommendations may include:

• Use of artificial tears, gels, and ointment 4 to 6 times a day
• Taping of eyelids at night (if they don’t close completely)
• Selenium supplementation

In the past, management options for moderate to severe disease included treatment options such as systemic corticosteroids, orbital irradiation, or off label use of biologic drugs. While these treatments may reduce the inflammation associated with the disease process, they have not been shown to reverse the disease process,  and can have significant systemic side effects. In 2020 the FDA approved the first and only medical treatment specifically for TED – Tepezza.

Tepezza is the first medical innovation in the field of TED.  It is based on many scientific innovations and contributions, as well as years of laboratory research. It is a humanized monoclonal antibody that specifically attaches to the (Insulin like growth factor 1 receptor) IGF-1R receptors that are overexpressed in TED, turning down the production of extracellular molecules, and the subsequent inflammation and tissue expansion associated with TED.  In short, this means the disease reverses with less eye bulging, double vision, facial changes and swelling. 

Tepezza is delivered as an infusion. Typically, it is given for 8 sessions, each 3 weeks apart. In previously published clinical trials, over 80% of patients saw improvement and of those 95% had long term improvement. The rate of reactivation of disease appears stable at 5% (meaning about 5% of patients may require retreatment). The side effects are mild or moderate and appear to reverse after infusion has stopped.

Prior to infusion, your physician should review your baseline lab work to ensure you are medically optimized for treatment and perform hearing screening. During the course of treatment, you should be monitored closely for any side effects, your hearing should also be assessed, blood sugar may also be monitored if you have a history of diabetes of hyperglycemia.  During each infusion, vital signs should be routinely and closely monitored.  Photographs and orbital imaging may also be obtained for the assessment of treatment efficacy. Following each treatment with Tepezza, you can consider infusion of IV vitamins and minerals, which may lessen some of the side effects.

Things to consider when choosing a doctor/infusion center for treatment with Tepezza:

• • • Does your doctor/infusion center offer treatment monitored by a team of TED specialists?
  • • Are there nurses devoted to Tepezza infusion?
  • • Is there close monitoring of potential side effects with additional testing for:
      • • • Hearing screening
        • • Blood sugar monitoring
        • Vital sign monitoring

  • Option of infusion of vitamins and minerals, which may offset side effects.

Find a TED Specialist to start your journey today!