KNOW THE TREATMENT OPTIONS AND GUIDELINES FOR THYROID EYE DISEASE (TED)

The diagnosis and management of TED are best done with a multidisciplinary team consisting of an ophthalmologist and endocrinologist1

Non-biologic treatment options—such as steroids, orbital radiotherapy, and surgery—do not target the underlying mechanism of the disease of TED2-5

Topical treatments

(eg, artificial tears, lubricating eye drops, and gels)6

Benefits

  • May provide relief for some symptoms of TED including dry, gritty eyes and eyelid retraction

Limitations

  • Temporary relief

Steroids

Benefits

  • Rapid onset of action7,8
  • May reduce inflammation3

Limitations

  • Marginal effects on proptosis,9,10 transient symptom relief11
  • High doses of prednisone for TED often required11
  • Does not affect disease progression3
  • Associated with serious adverse events and an increased risk of Cushing’s syndrome, weight gain, diabetes, hypertension, and more3,8,12,13
  • 20%-40% of patients who had improvements experienced flares within 12 weeks11

Orbital radiotherapy

Benefits

  • May blunt orbital fibroblast activation and increase apoptosis of nonactivated lymphocytes4
  • May improve ocular motility impairment and soft tissue changes in recent onset TED4

Limitations

  • Minimal effectiveness when used in later stages of the disease4
  • Little impact on proptosis/long-standing extraocular muscle dysfunction4

Surgery

Benefits

  • Partial functional and cosmetic restoration
  • Improve visual acuity in 44%-55% of patients14
  • Improve diplopia in 28% of patients14

Limitations

  • Does not address expansion of muscle tissue15
  • The process is typically long and may require multiple complex surgeries—sometimes as many as 4 or more—leading to loss of productivity for patients16,17
  • In orbital decompression surgery, visual acuity has been shown to worsen in 18%-20% of patients,14 and diplopia may be induced in 30% of patients14
  • Patients often do not return to baseline appearance16

Learn more about an FDA-approved treatment for TED

The 2022 consensus statement from the American Thyroid Association/European Thyroid Association recommend the management of TED utilize multidisciplinary decision-making between ophthalmologists and endocrinologists1

While each have unique roles, both can diagnose and treat TED
Ophthalmologist icon

Role of ophthalmologists
  • Looks for visible and nonvisible signs and symptoms of TED18
  • Assesses the full impact of TED on quality of life1
  • Partners with an endocrinologist for thyroid management1
  • Diagnoses and treats TED patients
Endocrinologist icon

Role of endocrinologists
  • Manages treatment of Graves’ disease or other thyroid conditions1
  • Screens all Graves’ disease patients for TED
  • Looks for visible and nonvisible signs and symptoms of TED
  • Assesses the full impact of TED on quality of life1
  • Partners with an ophthalmologist for a comprehensive TED eye exam1
  • Diagnoses and treats TED patients

By utilizing a multidisciplinary approach, you may shorten the time to TED diagnosis

It can take some TED patients up to 5 years to get an accurate diagnosis19

Some TED cases are more severe than others, like those that are sight threatening. In these severe cases, it is critical to refer to an ocular sub-specialist.1

 CONNECT WITH A SUB-SPECIALIST
Speak with an Amgen Representative thumbnail

TO LEARN MORE ABOUT TED, SPEAK WITH AN AMGEN REPRESENTATIVE

  1. Burch HB, Perros P, Bednarczuk T, et al. Management of Thyroid Eye Disease: a consensus statement by the American Thyroid Association and the European Thyroid Association. Thyroid. 2022;32(12):1-32.
  2. Patel A, Yang H, Douglas RS. A new era in the treatment of thyroid eye disease. Am J Ophthalmol. 2019;208:281-288.
  3. Bartalena L, Pinchera A, Marcocci C. Management of Graves’ ophthalmopathy: reality and perspectives. Endocr Rev. 2000 Apr;21(2):168-99.
  4. Chundury RV, Weber AC, Perry JD. Orbital Radiation Therapy in Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg. 2016 Mar-Apr;32(2):83-9.
  5. Siakallis LC, Uddin JM, Miszkiel KA. Imaging Investigation of Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg. 2018 Jul/Aug;34(4S Suppl 1):S41-S51.
  6. Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC. Graves’ ophthalmopathy: VISA versus EUGOGO classification, assessment, and management. J Ophthalmol. 2015;2015:249125.
  7. Perros P, Neoh C, Dickinson J. Thyroid eye disease. BMJ. 2009 Mar 6;338:b560.
  8. Zang S, Ponto KA, Kahaly GJ. Clinical review: Intravenous glucocorticoids for Graves’ orbitopathy: efficacy and morbidity. J Clin Endocrinol Metab. 2011 Feb;96(2):320-32.
  9. Douglas RS, Dailey R, Subramanian PS, et al. Proptosis and Diplopia Response With Teprotumumab and Placebo vs the Recommended Treatment Regimen With Intravenous Methylprednisolone in Moderate to Severe Thyroid Eye Disease: A Meta-analysis and Matching-Adjusted Indirect Comparison. JAMA Ophthalmol. 2022;140(4):328–335.
  10. van Geest RJ, Sasim IV, Koppeschaar HP, Kalmann R, Stravers SN, Bijlsma WR, Mourits MP. Methylprednisolone pulse therapy for patients with moderately severe Graves’ orbitopathy: a prospective, randomized, placebo-controlled study. Eur J Endocrinol. 2008 Feb;158(2):229-37.
  11. Bartalena L, Krassas GE, Wiersinga W, et al. Efficacy and safety of three different cumulative doses of intravenous methylprednisolone for moderate to severe and active Graves’ orbitopathy. J Clin Endocrinol Metab. 2012 Dec;97(12):4454-4463.
  12. Moleti M, Giuffrida G, Sturniolo G, et al. Acute liver damage following intravenous glucocorticoid treatment for Graves’ ophthalmopathy. Endocrine. 2016;54(1):259-268.
  13. Liu XX, Zhu XM, Miao Q, Ye HY, Zhang ZY, Li YM. Hyperglycemia induced by glucocorticoids in nondiabetic patients: a meta-analysis. Ann Nutr Metab. 2014;65(4):324-32.
  14. Braun TL, Bhadkamkar MA, Jubbal KT, Weber AC, Marx DP. Orbital decompression for thyroid eye disease. Semin Plast Surg. 2017 Feb;31(1):40-45.
  15. Hu WD, Annunziata CC, Chokthaweesak W, et al. Radiographic analysis of extraocular muscle volumetric changes in thyroid-related orbitopathy following orbital decompression. Ophthalmic Plast Reconstr Surg. 2010;26(1):1-6.
  16. Naik MN, Nair AG, Gupta A, Kamal S. Minimally invasive surgery for thyroid eye disease. Indian J Ophthalmol. 2015 Nov;63(11):847-853.
  17. Thyroid Eye Disease - What to Expect. Kellogg Eye Center University of Michigan Health. Accessed May 16, 2024. https://www.umkelloggeye.org/conditions-treatments/thyroid-eye-disease-what-expect
  18. Phelps PO, Williams K. Thyroid Eye Disease for the primary care physician. Dis Mon. 2014;60(6):292-298.
  19. Cockerham K, et al. Inactive thyroid eye disease patient journey. Presented at: Endocrine Society; June 15-18, 2023. Chicago, IL.

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