Thyroid eye disease (TED) is a chronic debilitating condition which causes physical discomfort, oculo-facial disfigurement and compromised visual function. Around 25% of people with Graves’ hyperthyroidism are affected by TED, where 1 in 20 patients might report with moderate-to-severe, active disease that will require medical management for reducing both TED activity and severity. The mainstay of medical management involves intravenous corticosteroids for active moderate-to-severe TED. After accurate understanding of the mechanism and pathophysiology of this disease, investigations and randomized clinical trials have been conducted. The role of immunotherapy targeting and influencing different biomolecular pathways including that of T cells, B cells, cytokines and cell surface receptors have been investigated in various randomized clinical trials. This review article addresses the epidemiology, associated risk factors, recent advances in pathophysiology, newer diagnostic tools and current management options available for TED which include the use of immunosuppressive drugs like rituximab (RTX), tocilizumab, infliximab (IFX), etanercept ( ETN) and teprotumumab etc.
Medical management of thyroid eye disease – A paradigm shift