*Recurrent TED was evidenced by prior medical or surgical intervention for TED, prior orbital imaging with diagnostic evidence for TED, or patient report of painless orbital inflammatory disease or photographs demonstrating a change in appearance consistent with TED.1
IGF-1R, insulin-like growth factor-1 receptor; MRI, magnetic resonance imaging; TED, Thyroid Eye Disease.
Images provided with permission from Jody Abrams, MD.
Images provided with permission from Mark Lupo, MD.
IR, inferior rectus; LR, lateral rectus; MR, medial rectus; SO, superior oblique; SR, superior rectus.
TED is more than proptosis. If your patients with thyroid conditions present with any of the following signs or symptoms, it could be TED9
Screen all patients with thyroid conditions for all visible signs and nonvisible symptoms of TED9,17
TSH, thyroid-stimulating hormone.
Patients with TED often show symptoms of dry eye disease19
DRY EYE DISEASE (DED): Affects lacrimal glands and ocular surface causing insufficient lubrication to aqueous tear-film layer20
The visible and nonvisible symptoms of TED can have a debilitating impact on your patients’ daily activities and self-confidence21-23
61% had trouble performing 1 or more daily activities23
(n=242/394)
45% Had trouble reading23
(n=177/394)
Based on an online 62-question survey of 443 TED patients with a diagnosis that ranged from <1 to >10 years23
71% felt their self-confidence had been negatively affected24
(n=50/70)
71%
(n=50/70)
felt their self-confidence had been negatively affected24
Based on responses from 70 patients with TED with a duration of disease ranging from 12 to 18 months who answered 16 questions from the GO-QOL questionnaire24
GO-QOL, Graves’ Ophthalmopathy Quality of Life.
Thyroid Eye Disease kind of put me into a shell. I didn’t want to do things with people and I didn’t want my picture taken.
ATA & ETA 2022 Consensus Statement Recommendation:
Assess the physical and psychosocial impact of TED for all patients17
Consider the signs and symptoms of TED, as well as patients’ ability to manage daily activities, for a deeper
understanding of disease burden
Patient-Reported Impact
Degree to which symptoms impact patients’ daily
activities and emotional well-being
Not an official medical tool.
SEE HOW THE BURDEN-IMPACT MODEL IS USEDThe Patient Intake Form includes the Burden-Impact Model—ask your AMGEN representative for a copy.
Some examples: eye pain, redness, swelling, eye bulging, and double vision. These are not all the signs and symptoms of TED
Some examples: walking outdoors, driving, reading
Some examples: negative impact to self-esteem, hiding their appearance in public
Kim: I'm Kim. And this is my journey with Thyroid Eye Disease.
When I was 17, I started to get really tired, and my mom was worried about me, so she took me to the doctor to have me checked for Mono. And the doctor did the blood work and said, you do not have Mono. I think it's just growing pains and kind of just sent me on my way.
And then I went to college where I was recruited to play volleyball and run track. When I went to the volleyball camp before the season, the coach called me into the office and she looked at me and she said, “You play like you're sick, I'm cutting you.” And I was devastated.
So, I went to a doctor on campus and he basically told me I was a hypochondriac.
My uncle is an ophthalmologist and he looked at me and said, ”Oh my gosh, you are so sick.” My uncle got me into an endocrinologist, and he said, “You have Graves’ disease and you need treatments immediately.”
So, I started radiation treatments. Once that was stabilized, my eye symptoms started to get worse. And my uncle at that time said, “You have Thyroid Eye Disease and it is independent from your Grave's disease.”
I had the tightness in my eyes. The bulging. And they kept getting worse and worse as time was going on. My eyelids wouldn't close. So, I was putting night eye ointment in all the time. I was using drops constantly, so I always knew my eyes were there. So, they got me into a ocular plastic surgeon and I had my first Levator surgery.
That took care of the major symptoms. But I was still using the eye ointment at night. I was still using drops.
I could drive during the day, but nighttime no, everything, all the lights were double.
You just kind of learn to live with those symptoms and move on because you think there's nothing you can do anymore. So, I thought this is just how it was going to be.
You just aren't comfortable anymore with yourself in your own skin and everything bothers you. I didn't want to really be around people. I didn't want to go to events. It got to a point where I didn't want to be out in public because people would look at me and I knew they were looking at my eyes.
Discovering TEPEZZA
After 25 years and four surgeries I said to my optometrist, I need some help. So that’s when she recommended that I see an oculoplastic surgeon and the new oculoplastic surgeon said, “Hey, there's this new medicine out called TEPEZZA. I think before we do any more surgeries on you, you should try it.
I had told her I saw the commercials and I said I didn't think it was an option for me because I thought I had to be in that bad phase with all those bad symptoms I had before.
And she said, “No, I’m pretty sure this is going to be it.”
Kim’s Treatment Experience & Results
When I went for my first infusion, I was very anxious.
Then after the second treatment, I got used to everything. And by the third treatment is when I really noticed that the pink in my eyes was gone. And then after the fourth treatment, I noticed the bulging had decreased.
It was exciting to, to see that.
The most significant difference was infusions five through eight. The tightness was gone. I was blinking normally again, and I could sleep without using eye ointment.
When I was done, my eye bulging, decreased three millimeters in each eye, which is a significant difference.
Post Treatment
To see myself now, after this treatment, it's been inspiring and uplifting and healing because I don't think about my eyes every day anymore. I can go about my day being confident and people aren't asking me about my eyes.
When my son got married, I actually couldn't wait to see the pictures. And you see a picture. You don't see eyes.
It's been an amazing experience. If I can help somebody who was in the same stage as I was and thinks they can't do this, they should make sure they ask their doctor, “is this an option for me?” Because I didn't think it was and it's been incredible.
I wish 25 years ago TEPEZZA would have been around because I would have gotten back 25 years of my life of not having to think or feel something constantly every day.
Infusion Reactions: TEPEZZA may cause infusion reactions. Infusion reactions have been reported in approximately 4% of patients treated with TEPEZZA. Reported infusion reactions have usually been mild or moderate in severity. Signs and symptoms may include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache, and muscular pain. Infusion reactions may occur during an infusion or within 1.5 hours after an infusion. In patients who experience an infusion reaction, consideration should be given to premedicating with an antihistamine, antipyretic, or corticosteroid and/or administering all subsequent infusions at a slower infusion rate.
Preexisting Inflammatory Bowel Disease: TEPEZZA may cause an exacerbation of preexisting inflammatory bowel disease (IBD). Monitor patients with IBD for flare of disease. If IBD exacerbation is suspected, consider discontinuation of TEPEZZA.
Hyperglycemia: Increased blood glucose or hyperglycemia may occur in patients treated with TEPEZZA. In clinical trials, 10% of patients (two-thirds of whom had preexisting diabetes or impaired glucose tolerance) experienced hyperglycemia. Hyperglycemic events should be controlled with medications for glycemic control, if necessary. Assess patients for elevated blood glucose and symptoms of hyperglycemia prior to infusion and continue to monitor while on treatment with TEPEZZA. Ensure patients with hyperglycemia or preexisting diabetes are under appropriate glycemic control before and while receiving TEPEZZA.
Hearing Impairment Including Hearing Loss: TEPEZZA may cause severe hearing impairment including hearing loss, which in some cases may be permanent. Assess patients’ hearing before, during, and after treatment with TEPEZZA and consider the benefit-risk of treatment with patients.
The most common adverse reactions (incidence ≥5% and greater than placebo) are muscle spasm, nausea, alopecia, diarrhea, fatigue, hyperglycemia, hearing impairment, dysgeusia, headache, dry skin, weight decreased, nail disorders, and menstrual disorders.
TEPEZZA is indicated for the treatment of Thyroid Eye Disease regardless of Thyroid Eye Disease activity or duration.
Please see Full Prescribing Information for more information.
WARNINGS AND PRECAUTIONS Infusion Reactions: TEPEZZA may cause infusion reactions. Infusion reactions have been reported in approximately 4% of patients treated with TEPEZZA. Reported infusion reactions have usually been mild or moderate in severity. Signs and symptoms may include transient increases in blood pressure, feeling hot, tachycardia, dyspnea, headache, and muscular pain. Infusion reactions
