Thyroid eye disease (TED) occurs in around 40 percent of people with Graves’ disease, an autoimmune disorder.

Common symptoms include eye irritation, inflammation, and redness. In more severe cases, people experience bulging, retraction of the eyelids, and pressure on the optic nerve.

Treatments can include:

  • home remedies
  • medications
  • surgeries

Some treatments address the TED itself, while others treat the underlying Graves’ disease.

There is ongoing research into better treatment options. Keep reading to find out the latest in TED management.

During the active phase of TED, home care may help relieve your symptoms. These include:

  • eye drops to lubricate the eye
  • cool compresses
  • wearing sunglasses for light sensitivity
  • wearing glasses with a prism for double vision (your eye specialist may recommend this)

IV infusions

Teprotumumab-trbw (Tepezza) is an antibody medication developed to relieve swelling in cases of TED. It eases the pressure on your optic nerve and reduces bulging of the eyes.

According to the Food and Drug Administration (FDA), this is the first drug approved for the treatment of TED.

Teprotumumab-trbw is an infused medication. This means it’s delivered through an intravenous (IV) needle in your arm. Treatment involves eight IV infusions.

Each infusion will be 3 weeks apart. Many people will notice symptom improvement in about 6 weeks. It’s important to get all of the required infusions to receive the full dose of the medication.

As with any medication, there can be side effects. Common side effects of teprotumumab-trbw include:

  • fatigue
  • muscle cramps
  • nausea
  • diarrhea
  • headaches

Antithyroid drugs

Graves’ disease is an autoimmune disease that attacks the thyroid. When under attack, your thyroid releases too much thyroid hormone. This is called hyperthyroidism.

Antithyroid drugs stop your thyroid from producing hormones. The goal is to bring thyroid levels to a healthy target.

Although TED often occurs with Graves’ disease, they are separate conditions. TED can still occur with low or normal thyroid levels. The conditions will run their own courses.

If your thyroid levels are too high or low, your healthcare provider will closely monitor your blood levels. This helps them determine whether treatment is working or needs to be adjusted.

Synthetic hormones

When the thyroid is removed levels can drop too low, according to 2016 guidelines by the American Thyroid Association (ATA) and you will be started on synthetic thyroid hormone.

In the case of low thyroid levels due to antithyroid drugs, your doctor will reduce your dose of the medication.

Selenium supplements

Clinical trials have found that taking selenium can reduce the toll TED takes on your cells.

Selenium is an antioxidant taken as an oral supplement. Your doctor can advise you on whether selenium might help your condition.

Botulinum toxin A

Your healthcare provider may suggest injecting botulinum toxin A (BTA) into your eye muscles to treat strabismus. This is when your eyes don’t correctly align with each other when you look at an object.

BTA can also be injected into the eyelid to improve its shape and position.

Injectable therapies are not permanent, so they can be used in active or inactive TED.

Radioiodine

While radioiodine has been used in treating Graves’ disease, a body of evidence has shown that it can worsen thyroid eye disease. According to the ATA guidelines, surgery or antithyroid medications are best in cases of moderate to severe TED.

Radiation therapy should be avoided, especially in people who are pregnant and those who smoke.

Thyroidectomy

There’s mixed evidence about the best way to treat Graves’ disease if you have active TED.

Surgery to remove all of your thyroid results in almost no chance of recurrence of Graves’ disease. However, there are some reasons a thyroidectomy may not be appropriate for you.

Eye surgery

Depending on the severity of TED, surgeries may be part of the treatment plan. These include:

  • orbital decompression
  • strabismus (eye muscle) surgery
  • eyelid retraction surgery

These surgeries are used to manage symptoms and restore the function and appearance of the eye.

Surgeons continue to improve techniques.

For example, orbital decompression surgery can be done through the nostrils, according to John Hopkins Medicine. The recovery time is quicker because no incisions are made in your skin.

There have been advances in surgeries and medications for TED, with better outcomes and less invasive approaches.

Talk with your doctor about the best options for treating your TED.