Thyroid Eye Disease: Management, Advances, and Future Opportunities

Abstract

Thyroid eye disease (TED), the most common extrathyroidal manifestation of Graves disease, is a debilitating autoimmune condition that significantly impacts quality of life and can threaten vision. This review highlights advances in the understanding of TED, particularly in pathophysiology, emerging treatments, novel surgical techniques, and the use of imaging and artificial intelligence (AI). Teprotumumab, the first Food and Drug Administration-approved drug for TED, has shown effectiveness in reducing proptosis, improving diplopia, and enhancing quality of life. Other therapies in development include alternative insulin-like growth factor-1 receptor antagonists, FcRn inhibitors, interleukin pathway antagonists, and thyroid-stimulating hormone receptor inhibitors, all of which offer promising potential. Surgical approaches, such as orbital decompression and eyelid correction, have also evolved, with minimally invasive techniques gaining favor. Diagnostic advancements in biomarkers could further enhance early detection and disease monitoring. AI tools for assessing disease severity and predicting treatment outcomes are also emerging. Despite significant progress in molecular understanding and treatment options, TED remains complex and continued research is essential to improve diagnostic precision and therapeutic outcomes.