By Counterforce Health Team —

Tepezza: Transforming the Treatment of Thyroid Eye Disease

For decades, people living with thyroid eye disease (TED) — also known as Graves’ eye disease — had very few treatment options beyond steroids or surgery. The condition often causes painful, disfiguring, and vision-threatening eye symptoms that can greatly affect daily life and self-esteem.

That changed in 2020, when the U.S. Food and Drug Administration (FDA) approved Tepezza® (teprotumumab-trbw), the first and only medication specifically developed to treat thyroid eye disease. This groundbreaking therapy offers a new way to reduce inflammation, eye bulging, and double vision — and for many patients, it has been truly life-changing.

What Is Tepezza?

Tepezza (teprotumumab-trbw) is a prescription medication used to treat Thyroid Eye Disease (TED) in adults.

It is a targeted biological therapy — meaning it works at the molecular level to stop the abnormal immune activity that drives the disease. Unlike older treatments that only manage symptoms, Tepezza directly interferes with one of the root causes of TED.

Tepezza is administered by intravenous (IV) infusion, usually in an outpatient clinic setting.

Understanding Thyroid Eye Disease

What Is TED?

Thyroid Eye Disease is an autoimmune disorder most commonly associated with Graves’ disease, a type of hyperthyroidism. In TED, the immune system mistakenly attacks tissues around the eyes, leading to inflammation and swelling.

Over time, this immune activity causes the muscles and fatty tissue behind the eyes to expand, pushing the eyes forward (proptosis).

Common Symptoms of TED

  • Bulging eyes (proptosis)
  • Eye pain or pressure
  • Redness and swelling of the eyelids
  • Double vision (diplopia)
  • Light sensitivity
  • Grittiness or dryness
  • Difficulty closing the eyes completely

In severe cases, the swelling can affect vision by compressing the optic nerve.

How Tepezza Works

Tepezza targets a key player in the immune system known as the insulin-like growth factor-1 receptor (IGF-1R).

In TED, IGF-1R works together with another receptor called the thyroid-stimulating hormone receptor (TSHR) to trigger inflammation and tissue growth behind the eyes.

Tepezza is a monoclonal antibody that binds to and blocks the IGF-1 receptor. This helps:

  1. Reduce inflammation and swelling in the tissues around the eyes.
  2. Prevent further tissue expansion and scarring behind the eyes.
  3. Reverse or improve symptoms such as eye bulging and double vision.

In short, Tepezza works by interrupting the autoimmune process that causes TED rather than just masking the symptoms.

How Tepezza Is Administered

  • Route: Intravenous (IV) infusion
  • Dosing schedule:
    • An initial infusion, followed by one infusion every 3 weeks, for a total of 8 infusions (over about 5 months)
  • Duration: Each infusion lasts roughly 60 to 90 minutes

Most patients complete the full course in about 6 months, though some may need follow-up treatments depending on response and recurrence.

Clinical Evidence and FDA Approval

Tepezza was approved by the FDA in January 2020, based on results from two landmark clinical trials (OPTIC and OPTIC-X).

Key findings:

  • 82% of patients receiving Tepezza showed significant improvement in eye bulging compared to 10% in the placebo group.
  • 69% of patients experienced a reduction in double vision.
  • Many participants noticed visible improvement after just 2–3 infusions.
  • Benefits continued to increase through the full treatment course.

These results demonstrated that Tepezza can not only stop TED from worsening but also reverse existing eye changes, something no prior medication had achieved.

Benefits of Tepezza

Tepezza offers a range of important benefits for people with active or moderate-to-severe TED:

  • Reduces eye bulging (proptosis)
  • Improves double vision
  • Decreases redness and swelling
  • Restores comfort and appearance
  • May reduce the need for corrective eye surgery

For many patients, these improvements lead to better vision, self-confidence, and quality of life.

Possible Side Effects

Like all medications, Tepezza can cause side effects. Most are mild to moderate and temporary, but it’s important to be aware of them.

Common side effects:

  • Muscle cramps
  • Nausea
  • Hair thinning
  • Fatigue
  • Dry skin
  • Diarrhea
  • Changes in taste (metallic taste)

More serious but less common side effects:

  • Hearing problems, including hearing loss or ringing in the ears (tinnitus)
  • Elevated blood sugar, especially in people with diabetes
  • Infusion reactions (flushing, shortness of breath, or headache during the infusion)

Patients are usually monitored during and after each infusion, and adjustments can be made if side effects occur.

Who Can Receive Tepezza

Tepezza is approved for adults with active, moderate-to-severe Thyroid Eye Disease.

It is most effective when started early in the disease course, before significant tissue scarring occurs.

Tepezza may not be suitable for:

  • People who are pregnant or planning to become pregnant (it can harm an unborn baby)
  • Patients with uncontrolled diabetes or significant hearing loss
  • Those with active infections or other immune conditions should be evaluated carefully before treatment

Monitoring and Follow-Up

During treatment, healthcare providers will:

  • Monitor blood sugar levels (especially in diabetic patients)
  • Check for hearing changes
  • Evaluate eye symptoms and appearance after each infusion
  • Track infusion reactions and general well-being

Follow-up visits continue even after the 8th infusion to monitor for recurrence of symptoms.

Practical Considerations

  • Preparation: Each infusion is given in a medical office or infusion center by trained professionals.
  • Scheduling: Consistent infusion timing every 3 weeks is important for best results.
  • Lifestyle: Avoid smoking, as it can worsen TED and reduce treatment effectiveness.
  • Insurance and support: The manufacturer and patient advocacy programs provide assistance with coverage, scheduling, and education.

The Bottom Line

Tepezza (teprotumumab-trbw) has revolutionized the treatment of Thyroid Eye Disease. By targeting the immune pathway that causes inflammation and tissue expansion behind the eyes, it helps restore comfort, vision, and confidence for patients who once had limited options.

For many, Tepezza represents more than just a treatment — it’s a turning point toward recovery and a renewed sense of normalcy.