Tepezza for Thyroid Eye Disease
Understanding TED and Why Tepezza Is Used
This section explains what TED does to the eyes and how Tepezza helps calm the disease process.
TED happens when the immune system inflames the tissues and muscles around the eyes. The eyelids can pull back, the eyes may bulge, redness and burning can increase, and double vision may appear. In severe cases, swelling can press on the optic nerve and threaten vision.
TED usually has an active phase, when inflammation and swelling are increasing, followed by an inactive phase, when the disease quiets down. Tepezza works best during the active phase. Our eye doctor will check which phase you are in and whether now is the right time to start treatment.
Tepezza blocks a special receptor in the tissues behind your eyes called the insulin-like growth factor-1 receptor. When TED is active, this receptor gets turned on and causes inflammation and swelling of the muscles and fat tissue around your eyes. By blocking this receptor, Tepezza reduces the swelling and inflammation at the source of the disease. This is different from treatments that only manage symptoms temporarily.
Clinical trials showed Tepezza can significantly reduce several symptoms of active TED. About 8 out of 10 patients experienced meaningful improvement in eye bulging, with an average reduction of about 3 millimeters. Around 70 percent of patients saw improvement in double vision. Many patients also reported less pain, redness, and swelling around their eyes.
Before You Start: Evaluation and Safety Checks
Before recommending Tepezza, our eye doctor will perform several tests and ask about your health history to make sure it is safe and right for you.
Our eye doctor will use special scales to measure how active your TED is and how severe the symptoms are. These scores help us decide whether you are in the best window for treatment and what improvements we can expect.
Tepezza can harm an unborn baby and may affect fertility in both men and women. If you are pregnant, planning to become pregnant, or breastfeeding, we will discuss these risks in detail. Women who can become pregnant need to use reliable birth control during treatment and for six months after the last infusion. Men should also use contraception during treatment and for four months after the last dose.
Tepezza can cause hearing loss or ringing in the ears in some patients. We will ask about any current hearing problems, and we recommend you let us know right away if you notice changes in your hearing during treatment. The hearing changes may improve after treatment ends, but some patients have lasting problems.
Tepezza can raise blood sugar levels, especially in people with diabetes. If you have diabetes, we will monitor your blood sugar more closely during treatment and may work with your endocrinologist or primary care doctor to adjust your diabetes medications if needed.
Tepezza may worsen inflammatory bowel disease, such as Crohn disease or ulcerative colitis. If you have IBD, we will talk about your current symptoms and coordinate with your gastroenterologist to watch for any flare-ups during treatment.
Your thyroid hormone levels need to be as stable as possible before starting Tepezza. We will check your thyroid function and work with your endocrinologist to make sure your thyroid condition is well managed throughout your treatment.
How Tepezza Treatment Works
This section explains how Tepezza is given, how long treatment lasts, and what you can expect during each visit.
Tepezza is given through an intravenous infusion into a vein in your arm. Each infusion takes about 60 to 90 minutes. The medicine drips slowly into your bloodstream, and a nurse or infusion specialist will monitor you during the entire process.
The standard course is eight infusions total. The first infusion is given at a lower dose, and then the dose increases starting with the second infusion. Infusions are given every three weeks, so the full treatment takes about 21 weeks, or roughly five months.
Tepezza infusions are given in an infusion center or outpatient clinic. We will help coordinate your appointments and make sure the center is convenient for you. You do not need to stay overnight in a hospital.
Some patients have mild reactions during or shortly after the infusion, such as muscle cramps, nausea, headache, or fatigue. The infusion team will watch for these reactions and can slow the infusion or give medications to help you feel more comfortable. Serious infusion reactions are rare.
Possible Side Effects and How We Monitor You
Like all medications, Tepezza can cause side effects. We will explain what to watch for and how we track your health during treatment.
The most common side effects include muscle cramps or spasms, nausea, hair loss or hair thinning, diarrhea, fatigue, changes in taste, dry skin, and changes in menstrual periods. Most of these are mild and improve after treatment ends.
Tepezza can raise blood sugar levels. If you have diabetes, we will ask you to check your blood sugar more often and let us know if your levels are higher than usual. We may need to adjust your diabetes medications during treatment.
Some patients notice hearing loss, muffled hearing, or ringing in the ears during treatment. Let us know right away if you have any changes in your hearing. We may refer you to an audiologist for a hearing test. In some cases, the hearing problems improve after stopping Tepezza, but some changes can be permanent.
Nausea and diarrhea are fairly common. If you have inflammatory bowel disease, Tepezza may cause a flare, so we will watch your symptoms closely and coordinate with your gastroenterologist.
A small number of patients have reactions during the infusion, such as high blood pressure, feeling short of breath, or headache. The infusion team is trained to recognize and manage these reactions quickly.
Older patients may be more sensitive to some side effects, such as changes in blood pressure or blood sugar. We will monitor you closely and adjust the treatment plan if needed.
What to Expect During and After Treatment
This section describes when you may start to see improvement, how long results last, and what happens when treatment is complete.
Some patients notice improvement in symptoms like redness, swelling, or eye discomfort within a few weeks. Reduction in eye bulging usually becomes more noticeable after several infusions. The full benefit of treatment is typically seen by the end of the eight infusion course.
The improvements from Tepezza can last for months or even years after treatment ends. TED usually becomes less active over time, and many patients remain stable after completing the infusion series. We will continue to monitor your eyes at follow-up visits.
Not every patient responds fully to Tepezza. If your symptoms improve but not completely, we will discuss other options. Some patients still need eyelid, muscle, or orbital decompression surgery after the active phase of TED has calmed down. Surgery can address remaining bulging, eyelid retraction, or double vision.
After your treatment is complete, we will schedule follow-up visits to check your eye health and make sure your TED remains stable. We will also coordinate with your endocrinologist to keep your thyroid levels under control.
Controlling your underlying thyroid condition is very important for keeping TED from getting worse. If you smoke, quitting is one of the best things you can do to protect your eyes. Smoking makes TED worse and can reduce how well Tepezza works.
Insurance, Cost, and Access
This section covers what to know about insurance coverage and financial assistance for Tepezza treatment.
Most insurance plans cover Tepezza for patients with active, moderate to severe TED. Our office can help verify your coverage and work with your insurance company to get prior authorization if needed. The process can take a few weeks, so we start this early.
The maker of Tepezza offers patient assistance programs to help with out-of-pocket costs, including copay support and financial counseling. We can connect you with these resources and help you apply.
We will work closely with your endocrinologist, your insurance company, and the infusion center to make sure your treatment goes smoothly. Our goal is to remove as many obstacles as possible so you can focus on getting better.
Frequently Asked Questions
Here are answers to common questions patients ask about Tepezza treatment.
Most patients feel fine during and after infusions and can drive themselves. However, some people feel tired or have mild side effects, so you may want to arrange a ride for your first infusion to see how you feel.
Tepezza treats the active inflammation and swelling, and it can lead to lasting improvements in bulging, double vision, and other symptoms. However, it does not cure the underlying autoimmune condition that causes TED. Keeping your thyroid levels stable and not smoking are important to help prevent TED from coming back.
If you need to reschedule an infusion, let us know as soon as possible. We will work with you to get back on track. Missing one infusion usually does not mean you have to start over, but staying as close to the schedule as possible gives you the best results.
Tepezza is designed for active TED, which is usually the phase before surgery. If you have already had surgery and your TED is now inactive, Tepezza may not provide additional benefit. However, every case is different, and our eye doctor will evaluate whether you might still be a candidate.
Most insurance plans that approve Tepezza will cover the full course of eight infusions, but this depends on your specific plan and any requirements like prior authorization. We will help you understand your coverage before you start treatment.
We Are Here to Help
If you have been diagnosed with thyroid eye disease, our eye doctor can evaluate your condition, explain your treatment options, and coordinate Tepezza therapy if it is right for you. We will support you through every step of the process.