Current Management of Thyroid Eye Disease

Purpose of review In this review, we review the current understanding of the pathogenesis and known associations in thyroid eye disease. We describe recent developments in treatment paradigms including recently approved agents, upcoming future therapies, and current technologies and strategies in approaching patients surgically. Recent findings The development of biologic agents, such as rituximab, tocilizumab, and most recently the human monoclonal antibody teprotumumab that binds to the IFG-1 receptor, has altered the management of patients in the active phase of thyroid eye disease. Randomized controlled trials have demonstrated teprotumumab infusion in the relatively early phase of orbital inflammation results in a durable reduction in proptosis and strabismus in the majority of patients. Regarding surgical management, many studies have described refining surgical techniques and approaches, with specific attention to customizing approaches based on pre-operative assessments and using computer-assisted technologies. New insights in gene expression have improved our understanding of the etiology of thyroid eye disease and helped to define the role of lifestyle modifications. Steroids continue to have a role in temporizing severe orbitopathy while teprotumumab is useful in patients with moderate disease activity when utilized within 9 months of disease onset. Advances/progress in surgical management continue to increase effectiveness and safety through an ideal, predictable, consistent approach remains elusive.