Thyroid eye disease therapy reference (2026)

Thyroid eye disease therapy in 2026 organises around the disease phase.

Active disease (the inflammatory phase, typically the first 18 to 24 months): teprotumumab is now the modern first-line in moderate-to-severe disease and in active TED with significant proptosis or diplopia. Intravenous corticosteroids remain an option for active disease, particularly in dysthyroid optic neuropathy. Mycophenolate, rituximab, and tocilizumab have evidence in active TED. Orbital radiotherapy has a role in selected patients.

Stable disease (the post-inflammatory phase): orbital decompression surgery for proptosis and pressure-related symptoms. Strabismus surgery for residual diplopia. Eyelid surgery for residual lid retraction.

Late-stage pipeline: follow-on IGF-1R-targeted programs (including subcutaneous formulations of teprotumumab-like molecules), FcRn antagonists with TED indications in late-stage trials, and other novel mechanism classes.

The cross-specialty integration matters. Endocrinology manages the underlying thyroid disease (typically Graves disease); ophthalmology manages the orbital and eye complications. Coordinated care between the two specialties shapes outcomes; integrated TED clinics in major centres are increasingly the standard.