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Ophthalmology Management

Article

A New Era of Targeted Treatment for TED

The landscape of thyroid eye disease treatment has been fundamentally transformed by advances in our understanding of disease pathophysiology.

By: Thomas A. Ciulla, MD, MBA
Ophthalmology Management January 12, 2026 Vol 30, Issue Subspecialties 2026

Clinical Scorecard: A New Era of Targeted Treatment for TED

At a Glance

CategoryDetail
Condition
Key MechanismsInvolves autoantibodies targeting TSHR and IGF-1R, leading to fibroblast proliferation, tissue expansion, and the interaction between TSHR and IGF-1R.
Target Population
Care Setting

Key Highlights

  • TED affects approximately 50% of patients with Graves disease.
  • Women are affected 5 times more frequently than men.
  • Smoking is the strongest modifiable risk factor for TED.
  • Teprotumumab is the first FDA-approved medication specifically for TED.
  • IGF-1R antagonism represents a transformative approach in TED treatment.
  • Corticosteroids have significant limitations and risks, necessitating new therapies.

Guideline-Based Recommendations

Diagnosis

    Management

    • Corticosteroids remain first-line treatment for moderate-to-severe TED.
    • IGF-1R antagonism is recommended for disease modification.
    • Consider supportive therapies and surgical options for comprehensive management.

    Monitoring & Follow-up

      Risks

        Patient & Prescribing Data

        Patients with moderate-to-severe TED, particularly those unresponsive to corticosteroids or with severe symptoms.

        Clinical Best Practices

        • Consider smoking cessation as a key intervention in TED management.
        • Utilize IGF-1R antagonists for patients with severe symptoms or those not responding to traditional therapies.
        • Incorporate supportive therapies alongside pharmacological treatments.
        • Monitor for side effects of corticosteroids during treatment.

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