About Thyroid Eye Disease

Thyroid Eye Disease (TED) or Graves’ orbitopathy is a potentially vision-threatening, chronic, autoimmune disease with variability in symptom presentation1-4


TED starts with an initial acute phase and progresses to a chronic phase4

Acute phase

  • Signs and symptoms worsen over time 4
  • Often characterized by changing symptoms (including proptosis and diplopia) and inflammation (including orbital pain, redness, and swelling) 4

Chronic phase

  • Signs and symptoms reach a plateau above normal 4
  • Often characterized by persistent symptoms, including proptosis, diplopia, and orbital pain 4
Natural course of TED4,5

Understanding of the therapeutic window in TED is evolving based on emerging research5

Therapeutic window

  • Current research shows IGF-1R activation may drive the pathophysiology of Thyroid Eye Disease throughout the course of disease 4-7
  • Initiating therapy early has been shown to be effective, but the therapeutic window may continue beyond the acute phase 5,8

Timing of medical intervention

  • The ideal timing for therapy is during the acute phase to reduce signs and symptoms and disease impact, but there may be a broader window for treatment 5,8,9
Evolving understanding of therapeutic window4,5

 IGF-1R, insulin-like growth factor-1 receptor.
*This is a theoretical model based on potential patient response when therapy is initiated during the chronic phase of TED.5

TED is separate and distinct from Graves’ disease, and diagnosis is often delayed10,11

Graves’ disease and TED have different underlying mechanisms1,12

  • TED may present before, during, or after diagnosis of Graves’ disease 1
  • Treatment of the underlying thyroid disease does not treat or improve the clinical manifestations of
    TED 13

Heterogeneity of TED

  • TED is a heterogeneous condition, and symptom presentation varies from patient to patient 4
  • Common presentations, such as red, uncomfortable, and watery eyes, are often misdiagnosed as the more common conjunctivitis or allergic eye disease 1,11,14

Hear from a TED Specialist in his own words

TED Treater

Read Transcript

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


TED can progress quickly, and early intervention may reduce disease impact. Early signs and symptoms of TED may include1,15,16:

dry eyes and grittiness icon dry eyes and grittiness icon

Dry eyes and grittiness

Red eyes icon Red eyes icon

Redness, swelling, and excessive tearing

Eyelid retraction icon Eyelid retraction icon

Eyelid retraction

Proptosis icon Proptosis icon

Proptosis

Pain and pressure icon Pain and pressure icon

Pressure and/or pain behind the eyes

Diplopia icon Diplopia icon

Diplopia

TED-signs-icon
  • Not all signs of TED may be visible so it’s important to ask your patients if they’re experiencing symptoms 17
Consequences of TED icon Consequences of TED icon

TED can be potentially debilitating18

Learn about the consequences of TED

INDICATION AND IMPORTANT SAFETY INFORMATION

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, and dry skin.

INDICATION

TEPEZZA is indicated for the treatment of Thyroid Eye Disease.

Please see Full Prescribing Information for more information.

INDICATION AND IMPORTANT SAFETY INFORMATION

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, and dry skin.

INDICATION

TEPEZZA is indicated for the treatment of Thyroid Eye Disease.

Please see Full Prescribing Information for more information.

REFERENCES:

1. Bahn RS. Graves’ ophthalmopathy. N Engl J Med. 2010;362(8):726-738. 2. Dickinson AJ, Hintschich C. Clinical manifestations. In: Wiersinga WM, Kahaly GJ, eds. Graves’ Orbitopathy: A Multidisciplinary Approach—Questions and Answers. 3rd ed. Basel, Switzerland: Karger; 2017:1-25. 3. Bartley GB, Fatourechi V, Kadrmas EF, et al. Long-term follow-up of Graves ophthalmopathy in an incidence cohort. Ophthalmol. 1996;103(6):958-962. 4. 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. 5. Ozzello DJ, Kikkawa DO, Korn BS. Early experience with teprotumumab for chronic thyroid eye disease. Am J Ophthalmol Case Rep. 2020;19:100744. doi:10.1016/j.ajoc.2020.100744. Published online May 15, 2020. 6. Pritchard J, Han R, Horst N, Cruikshank WW, Smith TJ. Immunoglobulin activation of T cell chemoattractant expression in fibroblasts from patients with Graves’ disease is mediated through the insulin-like growth factor I receptor pathway. J Immunol. 2003;170(12):6348-6354. 7. Smith TJ, Hoa N. Immunoglobulins from patients with Graves’ disease induce hyaluronan synthesis in their orbital fibroblasts through the self-antigen, insulin-like growth factor-I receptor. J Clin Endocrinol Metab. 2004;89(10):5076-5080. 8. Ozzello DJ, Dallalzadeh LO, Liu CY. Teprotumumab for chronic thyroid eye disease. Orbit. Published online 2021;1-8. 9. Dolman PJ. Grading severity and activity in thyroid eye disease. Ophthalmic Plast Reconstr Surg. 2018;34(4S suppl 1):S34-S40. 10. Mamoojee Y, Pearce SHS. Natural history. In: Wiersinga WM, Kahaly GJ, eds. Graves’ Orbitopathy: A Multidisciplinary Approach—Questions and Answers. 3rd ed. Basel, Switzerland: Karger; 2017:93-104. 11. Estcourt S, Hickey J, Perros P, Dayan C, Vaidya B. The patient experience of services for thyroid eye disease in the United Kingdom: results of a nationwide survey. Eur J Endocrinol. 2009;161(3):483-487. 12. Smith TJ, Hegedüs L. Graves’ disease. N Engl J Med. 2016;375(16):1552-1565. 13. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-1421. 14. Konuk O, Anagnostis P. Diagnosis and differential diagnosis in Graves’ Orbitopathy. In: Wiersinga WM, Kahaly GJ, eds. Graves’ Orbitopathy: A Multidisciplinary Approach—Questions and Answers. 3rd ed. Basel, Switzerland: Karger; 2017:74-92. 15. 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. 16. Patel A, Yang H, Douglas RS. A new era in the treatment of thyroid eye disease. Am J Ophthalmol. 2019;208:281-288. 17. 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. 18. 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.