Treating your thyroid eye disease (TED) can help reduce symptoms and prevent vision loss. Some people may use over-the-counter (OTC) options, such as lubricating eye drops, to relieve symptoms like dry eye. If OTC treatments or lifestyle changes aren’t enough, your doctor may suggest prescription medications.

Below are some of the treatment options your healthcare team may recommend.

Insulin-like growth factor-1 receptor (IGF-1R) inhibitors are biologic drugs that target a protein involved in TED. The U.S. Food and Drug Administration (FDA) has approved two options in this class for TED:

• Teprotumumab-trbw (Tepezza), approved in 2020
• Veligrotug-vvze (Lumvoa), approved in 2026

How Do IGF-1R Inhibitors Work?

Teprotumumab-trbw and veligrotug-vvze are monoclonal antibodies, lab-made proteins designed to target specific substances in the body. These medications bind to IGF-1R and block its signaling. This can help reduce inflammation and tissue changes behind the eyes and improve TED symptoms such as proptosis (bulging eyes) and diplopia (double vision).

How Do You Take IGF-1R Inhibitors?

Teprotumumab-trbw and veligrotug-vvze are given as infusions. Teprotumumab-trbw is given every three weeks for a total of eight infusions, while veligrotug-vvze is given every three weeks for a total of five infusions.

A version of teprotumumab-trbw that’s injected under the skin rather than infused is being studied. This version isn’t available yet, but studies have shown promise.

What Are the Side Effects of IGF-1R Inhibitors?

Some common side effects of teprotumumab-trbw include:

• Muscle spasms
• Nausea
• Hair loss
• Diarrhea
• Fatigue (extreme tiredness that doesn’t improve with rest)
• High blood sugar
• Hearing problems
• Dry skin
• Changes in taste
• Headache

Hearing problems caused by teprotumumab-trbw can be severe or permanent. The prescribing information recommends checking your hearing before, during, and after treatment.

Veligrotug-vvze has similar common side effects, including:

• Muscle spasms
• Headache
• Hearing problems
• High blood sugar
• Fatigue
• Diarrhea
• Ear discomfort
• Nausea
• Dry skin
• High blood pressure

The prescribing information for veligrotug-vvze also recommends checking your hearing before, during, and after treatment.

People with active, inflammatory TED may take corticosteroids to help reduce inflammation, pain, discoloration, and swelling. IV corticosteroids are generally preferred over oral corticosteroids for active, moderate to severe TED because they may work better and have fewer side effects.

Corticosteroids, such as prednisone and methylprednisolone, may help reduce inflammation and double vision but are less helpful for bulging eyes.

How Do Corticosteroids Work?

Corticosteroids are anti-inflammatory drugs. They decrease immune system activity and help reduce swelling around the eyes.

How Do You Take Corticosteroids?

You can take corticosteroids by mouth or receive them through an IV infusion. In some cases, a corticosteroid may be injected into the tissues around the eye.

What Are the Side Effects of Corticosteroids?

Corticosteroids can cause side effects, especially with higher doses or longer treatment. Side effects may include:

• Increased appetite
• Weight gain
• Mood changes
• Trouble sleeping
• Blurry vision
• Osteoporosis (weak bones)
• High blood sugar
• High blood pressure
• Swelling

Corticosteroids can also cause side effects that affect your eyes, including cataracts (clouding of the lens of your eye) and glaucoma (increased pressure inside your eye).

Tocilizumab is an off-label option for TED, which means it isn’t FDA approved for this use. It may be considered for some people with active, moderate to severe TED that hasn’t responded well to other treatment options.

How Does Tocilizumab Work?

Tocilizumab is a monoclonal antibody that blocks the receptor for a protein called interleukin-6 (IL-6). Blocking the IL-6 receptor can help reduce inflammation.

How Do You Take Tocilizumab?

For TED, tocilizumab may be given as a monthly IV infusion for at least four months.

What Are the Side Effects of Tocilizumab?

Common side effects include upper respiratory infections, headache, high blood pressure, and injection-site reactions. Tocilizumab also has a boxed warning for serious infections. Tocilizumab may also reactivate hepatitis B in people who have had the infection before.

Teprotumumab-trbw, veligrotug-vvze, corticosteroids, and tocilizumab all affect the immune system. In some cases, your healthcare provider may recommend other immunosuppressants, including:

• Azathioprine
• Cyclosporine
• Mycophenolate
• Rituximab

How Do Immunosuppressants Work?

Immunosuppressants help slow or stop the immune system’s attack on healthy tissue. This can help reduce inflammation in the tissues around your eyes.

How Do You Take Immunosuppressants?

Some immunosuppressants are taken by mouth, while others are given as an IV infusion. Your healthcare provider will tell you exactly how to take your medication.

What Are the Side Effects of Immunosuppressants?

Side effects vary depending on the medication. Because immunosuppressants reduce immune system activity, they can increase your risk of infection.

If you have mild, active TED, your healthcare provider may recommend a selenium supplement for six months. It’s uncertain whether selenium supplements benefit people with moderate to severe TED.

How Do Selenium Supplements Work?

Selenium is an essential mineral that helps your body carry out many important functions, including thyroid function. Taking selenium may improve symptoms related to inflammation and help prevent mild TED from progressing.

How Do You Take Selenium Supplements?

Selenium supplements are usually taken by mouth every day for six months. Talk with your healthcare provider about whether selenium is right for you and how much you should take.

What Are the Side Effects of Selenium Supplements?

Too much selenium can be harmful. Adults should not get more than 400 micrograms a day from food, drinks, and supplements unless a healthcare provider recommends otherwise.

Possible side effects of too much selenium include garlic-smelling breath, a metallic taste, nausea, diarrhea, hair loss, brittle nails, rash, fatigue, irritability, and nervous system problems.

Keeping your thyroid hormone levels in the normal range is an important part of managing TED. However, treating a thyroid problem does not necessarily resolve TED symptoms.

TED is often linked with Graves’ disease, which usually causes hyperthyroidism (high levels of thyroid hormones). TED can also occur in people with either normal thyroid hormone levels or hypothyroidism (low levels of thyroid hormones).

How Do Thyroid Medications Work?

Thyroid medications help bring thyroid hormone levels into the normal range. If you have hyperthyroidism, you may take antithyroid medications, such as methimazole or propylthiouracil, to block the thyroid from making too much hormone.

If you have hypothyroidism, treatment usually includes levothyroxine. This medication replaces thyroid hormone that your body does not make in sufficient amounts.

How Do You Take Thyroid Medications?

Most thyroid treatments are taken by mouth. How and when you take them depends on the medication, so follow your healthcare provider’s instructions.

What Are the Side Effects of Thyroid Medications?

Side effects depend on which medication you take. Antithyroid medications can cause rash, upset stomach, nausea, vomiting, taste changes, dizziness, hair loss, and headache.

Levothyroxine can cause side effects such as weight or appetite changes, headache, heat sensitivity, diarrhea, hair loss, joint pain, leg cramps, and menstrual cycle changes.

Researchers continue to study new treatments for TED and new ways to give existing treatments. Clinical trials are research studies that test drugs and other approaches to find out how safe and effective they are.

Talk with your healthcare provider if you’re interested in joining a TED clinical trial. They can help you understand possible benefits and risks and whether a clinical trial might be right for you.

Join the Conversation

On TEDhealthteam, people share their experiences with thyroid eye disease, get advice, and find support from others who understand.

What medications or supplements have you tried for TED? Let others know in the comments below.