Thyroid Eye Disease Treatments
Thyroid eye disease (TED) affects every person differently. Our specialists provide a personalized treatment plan to best fit your individual needs, reduce ocular (eye-related) symptoms, and prevent vision loss.
Your treatment team will include an ophthalmologist, who specializes in plastic surgery of the eye, and an endocrinologist, a doctor specializing in conditions that affect hormones. Your team may also include other care providers, depending on your personal medical history.
Stanford Health Care's team includes doctors who are renowned TED experts. These specialists can start the right treatment early in the course of your disease. Your care plan may include:
Medication
Radiation
Surgery
Medication and Support
Tepezza (teprotumumab)
Tepezza (teprotumumab) is the only treatment approved by the FDA for moderate to severe thyroid eye disease. Stanford Health Care was the first academic medical center in the country to successfully treat a patient with Tepezza. We have used this therapy to help many people with TED, including patients with sight-threatening disease.
Tepezza is a monoclonal antibody that works against the insulin-like growth factor-1 receptor (IGF-1R). You receive it as an IV infusion every three weeks for a total of eight treatments. By inhibiting your body’s inflammatory response, Tepezza prevents muscle and fat behind the eye from expanding.
Research has shown that people taking Tepezza show significant improvement in:
- Double vision (diplopia)
- Eye bulging (proptosis)
- Eye inflammation
- Quality of life
Corticosteroids
Corticosteroids inhibit the immune system and reduce inflammation behind the eye. This medication effectively reduces inflammatory symptoms of TED, such as:
- Pain
- Redness
- Swelling
We typically prescribe weekly infusions of steroids for 12 weeks. Infusions are more effective and have fewer side effects than oral steroids (taken by mouth).
Actemra® (Tocilizumab)
Actemra (Tocilizumab) is another medication that inhibits the immune response to reduce inflammation of the tissues around the eye. It is a monoclonal antibody to the interleukin-6 receptor and treats other diseases, such as rheumatoid arthritis.
People with active moderate or severe TED receive Actemra as a monthly IV infusion for a minimum of four months.
Selenium
For individuals with mild, active TED, we suggest taking selenium supplements twice a day for six months. A naturally occurring mineral found in soil, selenium improves inflammatory symptoms.
Thyroid dysfunction correction
Achieving normal thyroid function is the cornerstone of treatment for thyroid eye disease. Our specialists may treat thyroid dysfunction with:
- Medications that reduce the production of thyroid hormone (in hyperthyroidism) or replace thyroid hormone (in hypothyroidism)
- Radioactive iodine ablation to destroy overactive thyroid cells (in hyperthyroidism)
- Thyroid surgery to remove the thyroid gland (in hyperthyroidism)
Eye surface therapy
People with TED commonly experience dry eyes and eye pain because of inflammation. We may prescribe:
- Anti-inflammatory eye drops
- Artificial tear drops
- Lubricating eye gels
Smoking cessation
Smoking is a risk factor for thyroid eye disease and can also make the condition harder to treat. Therefore, smoking cessation is another essential part of TED treatment.
At Stanford Health Care, we understand that quitting is a process that requires comprehensive, customized support. Learn more about our Tobacco Treatment Services.
We offer these research-based therapies:
- Individual counseling sessions
- Nicotine replacement and cessation medication
- Smoking cessation support group with mindfulness skills coaching
Emotional support
Thyroid eye disease can change your facial appearance. For some people, this can cause emotional distress, including depression and anxiety. Psychologists at our Outpatient Psychiatry Clinic work with you to overcome any mental health concerns and enhance your quality of life.
Radiation
In some cases, our specialists combine corticosteroids with orbital radiotherapy. Radiotherapy delivers radiation behind your eye to reduce inflammation.
Research shows that for some people, this combination can be more effective than either treatment by itself. We may suggest both treatments for people with moderate to severe active TED.
Surgery
When thyroid eye disease is stable and not in the inflammatory stage, we may perform surgery to improve TED symptoms or cosmetic concerns. Depending on your needs, surgical options include:
- Orbital decompression: We may remove excess fat or bone to reposition the eye in the socket and treat eye bulging.
- Strabismus surgery: Procedures can tighten or loosen eye muscles to correct double vision.
- Eyelid surgery (blepharoplasty or retraction repair): Surgery repositions the eyelids so the eyes can open and close as they should. When necessary, we also remove excess skin and fat to restore vision and the natural appearance of the eyelids.
