August 04, 2025
2 min learn
Ophthalmologists are a essential a part of the medical workforce wanted to deal with thyroid eye illness.
An endocrinologist is normally the workforce chief, however ophthalmologists, diagnostic and therapeutic radiologists, together with an otolaryngologist/audiologist are different vital workforce members.
Generally, the systemic signs of hyperthyroidism precede the ocular findings, and the prognosis of thyroid eye illness (TED) has been made and remedy initiated earlier than an ophthalmologist is consulted. Nevertheless, we ophthalmologists make the first prognosis in some sufferers. Vital findings embrace diplopia and ocular motility discount, particularly in upgaze, eyelid retraction, publicity with ocular floor illness, elevated IOP and, in fact, proptosis. When an ophthalmologist suspects the prognosis, we contact the affected person’s main care doctor, and ideally the affected person is referred to an endocrinologist at a tertiary middle with a longtime TED administration and remedy workforce.
Some eye illnesses, similar to glaucoma, are seeing a transition from medical remedy to interventional remedy with earlier laser and surgical procedures. TED is the alternative. For the reason that approval of Tepezza (teprotumumab-trbw, Amgen) in 2020, the first-line remedy for TED with vital ocular indicators and signs is medical remedy. The imaginative and prescient indicators and signs in TED are attributable to the infiltration of cells with secondary edema, together with venous and lymphatic stasis, within the periorbital fats and ocular muscle mass, inflicting swelling and growth of those tissues. Tepezza, an insulin-like development factor-1 receptor inhibitor, reverses the mobile infiltration and periocular tissue swelling. Tepezza remedy for TED is to me much like anti-VEGF remedy for moist age-related macular degeneration. Nevertheless, quite than a number of intravitreal injections of an anti-VEGF as employed in moist AMD, TED remedy requires a number of intravenous infusions of a biologic. The primary course of remedy includes eight 60- to 90-minute intravenous infusions, one each 3 weeks. It’s costly, normally requires insurance coverage preauthorization, and is normally delivered at an infusion middle, generally affiliated with an endocrinologist at a tertiary TED remedy middle. Every of us wants one or two most popular facilities to advocate to our sufferers with TED.
The remedy success price with Tepezza is excessive, with 71% to 83% of sufferers in research responding to a single course of remedy. Some sufferers require a second and even third course of remedy with Tepezza, and a few don’t reply. In these instances, different medical remedy, radiologic remedy or surgical decompression could also be required.
With 5 years of remedy expertise utilizing Tepezza, we now have better perception into potential problems and negative effects. A essential one is listening to impairment. An audiologist related to an otolaryngologist can observe sufferers for this complication and detect it early. Within the scientific trials, different hostile reactions that occurred in 5% or extra of handled sufferers had been muscle spasms, nausea, alopecia, diarrhea, fatigue, hyperglycemia, dysgeusia, headache, dry pores and skin, weight reduction and nail issues. All these systemic negative effects are managed by others. Ocular findings are normally improved, however some sufferers don’t reply. Throughout and after remedy, an ophthalmologist should handle the publicity with ocular floor illness, refractive wants, diplopia and probably elevated IOP and monitor for the dreaded optic nerve compression with fundus examination, shade imaginative and prescient and visible fields.
It’s essential for all sufferers with TED to quit smoking. Senior sufferers may be handled with Tepezza, however remedy throughout being pregnant might trigger fetal hurt, and the security and effectiveness of Tepezza has not been established for pediatric use.
We’ve got beforehand lined the administration and remedy of TED in Healio | OSN cowl tales with my accompanying perspective within the June 10, 2021, and Dec. 10, 2023, points. These can be found to the reader and supply replace together with the duvet story on this difficulty.
References:
For extra data:
Richard L. Lindstrom, MD, may be reached at rllindstrom@mneye.com.
Sources/Disclosures
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Disclosures:
Lindstrom stories having monetary disclosures for Allergan, Bausch + Lomb, CorneaGen, Harrow, Imprimis, Minnesota Eye Consultants, Orasis and Unifeye Imaginative and prescient Companions.
