Understanding Thyroid Eye Disease (TED)

TED and Graves’ disease have different underlying mechanisms1,2

TED:

  • Is a serious, chronic autoimmune disease that can lead to long-term repercussions1,3-5
  • Is progressive, can worsen vision, and can potentially lead to optic neuropathy3,6,7
  • Can present with a variety of signs and symptoms3,7
  • Can reactivate or flare8
  • May lead to psychosocial difficulties9,10

IGF-1R drives the pathophysiology of TED throughout the course of disease3,11


TED can progress over time, and early intervention has been shown to reduce disease impact. Early signs and symptoms of TED may include the following1,3,12:

Dry, gritty eyes Dry, gritty eyes

Dry eyes and grittiness

Red, swollen eyes Red, swollen eyes

Redness, swelling, and excessive tearing

Pulled-back, or retracted, eyelid Pulled-back, or retracted, eyelid

Eyelid retraction

Protruding eye Protruding eye

Proptosis

Eye pain or pressure Eye pain or pressure

Pressure and/or pain behind the eyes

Double vision represented by two eyes merged on top of each other Double vision represented by two eyes merged on top of each other

Diplopia

TED-signs-icon TED-signs-icon TED-signs-icon
  • Not all signs of TED may be visible, so it’s important to ask your patients if they’re experiencing new or changing symptoms13

Hear how TEPEZZA has changed the way Dr. Gary Lelli treats TED11

Dr. Gary Lelli discusses the signs and symptoms of TED and the struggles his patients with TED often experience as a result.

Dr Gary Lelli thumbnail
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My name is Gary Lelli. I’m a physician and oculoplastic surgeon specialist in New York City where I take care of patients who have eyelid, lacrimal and orbital disorders.

When patients first come to me they're feeling quite anxious. They've had a drastic change in the way that they appear and they want to know why it's happening.

It's disabling. If you're used to seeing one image and all of a sudden you begin seeing two images, you're now struggling to drive, you're worried about walking down steps and falling. It's something that's on their mind almost every minute of the day.

My most recent patient, she had told me that in addition to struggling to see, which was limiting her ability to do work. She was also routinely shutting her camera off on her Zoom calls. She became uncomfortable showing her face on camera. We're really highlighting that two things can occur here. One, she's struggling with her function. Two, now she's limiting her interaction with her colleagues because she's distraught by her appearance.

TEPEZZA really has changed the way we can think about taking care of these patients. It's our first and only FDA approved treatment for thyroid eye disease. It's been shown to be effective in decreasing proptosis, reducing diplopia for patients, improving patient's functional vision and appearance, and decreasing the inflammatory signs of the disease namely, pain and swelling.

It's really changed the way we think about the disease, but also, it's given the patients hope that there's something they can do early in the disease process that will change the course. I'm noticing on most of these patients after two or three infusions, they have significant improvement already in multiple aspects of their disease. What that allows them to do is get back to feeling like themselves again and get back to functioning again much quicker.

Consequences of TED icon Consequences of TED icon

TED can be potentially debilitating7

Learn about the consequences of TED

INDICATION

TEPEZZA is indicated for the treatment of Thyroid Eye Disease.

IMPORTANT SAFETY 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 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 managed with medications for glycemic control, if necessary. Monitor patients for elevated blood glucose and symptoms of hyperglycemia while on treatment with TEPEZZA. Patients with preexisting diabetes should be under appropriate glycemic control before receiving TEPEZZA.

Adverse Reactions

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, and menstrual disorders.

Please see Full Prescribing Information for more information.

INDICATION

TEPEZZA is indicated for the treatment of Thyroid Eye Disease.

IMPORTANT SAFETY 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 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 managed with medications for glycemic control, if necessary. Monitor patients for elevated blood glucose and symptoms of hyperglycemia while on treatment with TEPEZZA. Patients with preexisting diabetes should be under appropriate glycemic control before receiving TEPEZZA.

Adverse Reactions

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, and menstrual disorders.

Please see Full Prescribing Information for more information.

1. Bahn RS. Graves’ ophthalmopathy. N Engl J Med. 2010;362(8):726-738. 2. Wang Y, Patel A, Douglas RS. Thyroid eye disease: how a novel therapy may change the treatment paradigm. Ther Clin Risk Manag. 2019;15:1305-1318. doi:10.2147/TCRM.S193018 3. Patel A, Yang H, Douglas RS. A new era in the treatment of thyroid eye disease. Am J Ophthalmol. 2019;208:281-288. 4. Rundle FF, Wilson CW. Development and course of exophthalmos and ophthalmoplegia in Graves’ disease with special reference to the effect of thyroidectomy. Clin Sci. 1945;5(3-4):177-194. 5. Ugradar S, Kang J, Kossler AL, et al. Teprotumumab for the treatment of chronic thyroid eye disease. Eye (Lond). 2021. doi:10.1038/s41433-021-01593-z. 6. 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;97(12):4454-4463. 7. Ponto KA, Merkesdal S, Hommel G, Pitz S, Pfeiffer N, Kahaly GJ. Public health relevance of Graves’ orbitopathy. J Clin Endocrinol Metab. 2013;98(1):145-152. 8. Data on File. Horizon, November 2020. 9. Kahaly GJ, Petrak F, Hardt J, Pitz S, Egle UT. Psychosocial morbidity of Graves’ orbitopathy. Clin Endocrinol (Oxf). 2005;63(4):395-402. 10. Park JJ, Sullivan TJ, Mortimer RH, Wagenaar M, Perry-Keene DA. Assessing quality of life in Australian patients with Graves’ ophthalmopathy. Br J Ophthalmol. 2004;88(1):75-78. 11. TEPEZZA (teprotumumab-trbw) [prescribing information] Horizon. 12. Douglas RS, Kahaly GJ, Patel A, et al. Teprotumumab for the treatment of active thyroid eye disease. N Engl J Med. 2020;382(4):341-352. 13. 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. doi:10.1155/2015/249125.