If your eyes have started bulging, feel gritty all the time, or you’ve noticed double vision creeping in, thyroid eye disease could be the reason. It’s more common than most people realize, and 2026 brought the biggest treatment update this condition has seen in years.
A patient-friendly guide by RealMedVision.
Medically reviewed: 10 to 13 minute read
Quick Answer
Thyroid eye disease treatment depends on how active and severe your symptoms are. Mild cases are often managed with supportive care and monitoring, while moderate to severe or sight-threatening disease needs medical therapy such as steroids or an IGF-1R inhibitor like teprotumumab (Tepezza) or the newly approved veligrotug (Lumvoa), sometimes followed by surgery once the disease settles.
Key Takeaways
- About 40% of people with Graves disease develop thyroid eye disease symptoms at some point.
- Smoking is the strongest modifiable risk factor, and the risk rises with how many cigarettes a person smokes.
- The FDA approved veligrotug (brand name Lumvoa) on June 26, 2026, the first TED therapy labeled for both active and chronic disease.
- Veligrotug is given as 5 infusions over 12 weeks, compared to teprotumumab’s 8 infusions over 21 weeks.
- Both drugs work by blocking IGF-1R, but they are not interchangeable, and your doctor decides which fits your disease phase.
What Is Thyroid Eye Disease
Thyroid eye disease, sometimes called TED or Graves orbitopathy, is an autoimmune condition where the tissue and muscles around the eyes become inflamed and swollen. It’s closely linked to Graves disease, an overactive thyroid condition, though it can occasionally show up in people with normal or underactive thyroid function too. The immune system mistakenly attacks tissue behind the eyes, causing swelling that pushes the eyeball forward. This is why bulging eyes, known as proptosis, is one of the most recognizable signs. Around 40% of people with Graves disease report TED symptoms at some point, ranging from mild irritation to serious vision-threatening complications.
Symptoms and Risk Factors
Common Symptoms
Early thyroid eye disease often feels like nothing more than dry, irritated eyes. Many people brush it off as allergies or screen fatigue. As it progresses, symptoms can include eye bulging, double vision, redness, swelling around the eyes, pressure or pain behind the eyes, difficulty closing the eyelids fully, and in advanced cases, pressure on the optic nerve that threatens eyesight.
How Doctors Measure Disease Activity
Doctors track disease activity using something called the Clinical Activity Score, or CAS. A score of 3 or higher generally suggests the disease is in an active, inflammatory phase rather than a stable, burned-out one. This distinction matters a lot for treatment planning, since active-phase disease responds differently to therapy than chronic disease does. The active phase typically lasts 2 to 3 years before it settles into a more stable, chronic state.
Risk Factors
The single strongest modifiable risk factor is cigarette smoking. Research consistently shows that the more a person smokes, the higher their risk of developing TED and the more severe it tends to be. Quitting smoking is one of the few things a patient can directly control. Other risk factors are not modifiable, including being female, older age, genetic predisposition, prior radioactive iodine therapy for thyroid conditions, and having a coexisting autoimmune disease.
| EUGOGO Stage | Description | Typical Management |
|---|---|---|
| Mild | Mild eyelid retraction, minimal double vision, no threat to sight | Lubricating drops, smoking cessation, monitoring |
| Moderate-to-severe | Noticeable proptosis, persistent double vision, affects daily function | IV steroids, IGF-1R inhibitor therapy, sometimes radiotherapy |
| Sight-threatening | Optic nerve compression, risk of permanent vision loss | Urgent high-dose IV steroids, often followed by decompression surgery |
Treatment Options Overview
Treatment for thyroid eye disease is chosen based on how active the disease is and how severe the symptoms are, not on a one-size-fits-all protocol.
Conservative and Supportive Care
For mild cases, doctors often start conservatively. Lubricating eye drops, cool compresses, sunglasses for light sensitivity, and simply quitting smoking can meaningfully slow progression. Selenium supplementation is sometimes used in mild, active disease, based on evidence it may reduce symptom progression, though it is not a substitute for medical evaluation.
Intravenous Steroids (IVMP)
For moderate to severe active disease, intravenous methylprednisolone, often shortened to IVMP, has long been a standard first-line treatment. It’s typically given in weekly pulses over several weeks to calm the inflammatory response. IVMP can reduce swelling and improve symptoms, but it does not reliably reverse proptosis or double vision the way newer targeted therapies can, and long-term or high cumulative doses carry liver and cardiovascular risks that doctors monitor closely.
Radiotherapy
Orbital radiotherapy is another option, sometimes used alongside steroids, particularly for double vision and muscle involvement. It’s generally reserved for specific patient profiles and is not considered a first-line therapy for most people today.
Surgery
Surgery has a well-defined but later role in the treatment pathway. Orbital decompression surgery is used for sight-threatening cases where the optic nerve is compressed, or for patients with disfiguring proptosis once the disease has become stable. Eye muscle surgery and eyelid surgery are typically done after the active phase has resolved, since operating during active inflammation tends to produce less predictable results. This is why many patients follow a sequence: control the active disease first, then address the residual changes with corrective surgery once things have stabilized.
The biggest shift in TED care over the past several years has been the arrival of IGF-1R inhibitor drugs, which directly target the biological mechanism driving the disease rather than just suppressing inflammation broadly. Teprotumumab was the first of these, and veligrotug is the newest.
Teprotumumab (Tepezza): First IGF-1R Inhibitor
Teprotumumab, sold under the brand name Tepezza, was approved in 2020 and became the first drug specifically designed to target the IGF-1R pathway involved in thyroid eye disease. Rather than broadly suppressing the immune system the way steroids do, it blocks a specific receptor, insulin-like growth factor 1 receptor, that plays a central role in the inflammation and tissue expansion behind the eyes.
Teprotumumab is given as 8 infusions over 21 weeks, roughly once every three weeks after the first two doses. It was studied and is primarily indicated for the active phase of thyroid eye disease, when inflammation is still driving the changes in proptosis and eye movement. For many patients, it represented a genuine step forward compared to steroids alone, since clinical trials showed meaningful reductions in eye bulging and double vision.
Because it was the first drug of its kind, teprotumumab set the template for how IGF-1R inhibitors are studied and used in TED. It remains a standard option for active-phase disease, and understanding how it works is useful context for evaluating the newer drug that has since entered the market.
New: Veligrotug (Lumvoa), 2026 FDA Approval
On June 26, 2026, the FDA approved veligrotug-vvze, marketed as Lumvoa by Viridian Therapeutics, under Priority Review and Breakthrough Therapy Designation. This approval matters for a specific reason beyond just adding another drug to the market: veligrotug is the first thyroid eye disease therapy labeled for both active and chronic disease phases. Previous options, including teprotumumab, were studied and indicated primarily for active disease, leaving a gap for patients whose disease had moved into a chronic, stable phase but who still had significant symptoms.
Like teprotumumab, veligrotug works as a full IGF-1R antagonist monoclonal antibody, blocking the same receptor pathway implicated in the tissue changes behind the eyes. Where it differs is in the treatment schedule and the phase of disease it’s approved to treat. Veligrotug is administered as 5 intravenous infusions of 10 mg per kg, given every 3 weeks, for a total 12-week course. That’s a shorter regimen than teprotumumab’s 8 infusions over 21 weeks, which may be meaningful for patients weighing treatment burden alongside efficacy.
In clinical trials, veligrotug produced a mean proptosis reduction of 2.9mm, a clinically meaningful improvement in the degree of eye bulging. For patients and clinicians, the ability to treat chronic-phase disease with a targeted biologic, rather than relying on steroids or surgery alone once the active phase has passed, is the most significant part of this approval. It’s worth noting this is a new drug, so real-world data and longer-term outcomes will continue to build over the coming years.
| Feature | Teprotumumab | Veligrotug |
|---|---|---|
| FDA approval | 2020 | June 26, 2026 |
| Infusions | 8 | 5 |
| Course duration | 21 weeks | 12 weeks |
| Dosing | Weight-based label dosing | 10mg/kg every 3 weeks |
| Phase indication | Primarily active | Active and chronic |
| Mechanism | IGF-1R antagonist antibody | Full IGF-1R antagonist antibody |
| Key trial result | Reduced proptosis and diplopia | Mean proptosis reduction 2.9mm |
| Risk Factor | Modifiable | Notes |
|---|---|---|
| Smoking | Yes | Strongest modifiable risk, dose-dependent |
| Female sex | No | Diagnosed more often in women |
| Advancing age | No | Risk rises with age |
| Genetic predisposition | No | Family history plays a role |
| Radioactive iodine therapy | Partially | Discuss timing with your doctor |
| Coexisting autoimmune disease | No | Raises overall risk |
Side Effects and Risks
Steroid-Related Risks
Intravenous steroids, while effective at reducing inflammation, can cause elevated blood sugar, mood changes, sleep disruption, and with prolonged or high cumulative dosing, liver and cardiovascular strain, which is why doctors monitor liver function during treatment.
IGF-1R Inhibitor Risks
For IGF-1R inhibitors as a class, hearing-related side effects have been an area of attention, and hearing impairment is a recognized risk that doctors screen for during treatment. With veligrotug specifically, infusion reactions occurred in approximately 9% of patients in clinical trials, and hyperglycemia, meaning elevated blood sugar, was reported in about 12% of patients, including some who did not have diabetes beforehand.
This is an important point for anyone with a personal or family history of diabetes to discuss with their care team before starting therapy.
Surgical Risks
Surgical options carry the usual risks associated with any orbital or eyelid procedure, including infection, bleeding, and the possibility that further surgery may be needed for optimal results. None of this information should be used to self-select a treatment. Your endocrinologist and ophthalmologist will weigh your specific health history, disease phase, and severity before recommending a course of treatment.
When to See a Doctor
Thyroid eye disease can progress gradually, which makes it easy to dismiss early symptoms. See a doctor promptly if you notice new or worsening eye bulging, double vision that wasn’t there before, persistent redness or swelling around the eyes, or difficulty closing your eyelids completely.
Some symptoms need urgent attention rather than a routine appointment. Sudden vision loss or blurring, severe eye pain, or a noticeable change in color vision can signal optic nerve compression, which is a sight-threatening emergency. If you already have a Graves disease or thyroid condition diagnosis and develop any of these symptoms, contact your doctor or seek emergency care right away rather than waiting to see if it improves on its own.
Frequently Asked Questions
What is the best treatment for thyroid eye disease?
There isn’t a single best treatment for everyone. The right approach depends on how active and severe the disease is, ranging from supportive care and steroids for milder cases to IGF-1R inhibitor therapy or surgery for more advanced disease. An endocrinologist or ophthalmologist experienced in TED can determine the right path for your specific case.
What is the newest treatment for thyroid eye disease in 2026?
Veligrotug, sold as Lumvoa, is the newest FDA-approved treatment, cleared on June 26, 2026. It stands out as the first therapy labeled for both active and chronic phases of thyroid eye disease, not just the active phase.
Is there a permanent cure for thyroid eye disease?
There is currently no permanent cure for thyroid eye disease. Treatments aim to control inflammation, reduce symptoms like proptosis and double vision, and prevent vision-threatening complications. Many patients see significant, lasting improvement with treatment, especially once the disease moves from the active phase into a stable, chronic phase.
What is Lumvoa (veligrotug) used for?
Lumvoa, the brand name for veligrotug, is used to treat thyroid eye disease. It is approved for both the active and chronic phases of the condition, given as 5 intravenous infusions over a 12-week course.
How is veligrotug different from teprotumumab (Tepezza)?
Both drugs are IGF-1R antagonist monoclonal antibodies, but veligrotug is approved for both active and chronic disease while teprotumumab is primarily indicated for active disease. Veligrotug’s course is also shorter, 5 infusions over 12 weeks compared to teprotumumab’s 8 infusions over 21 weeks.
Can thyroid eye disease be treated without surgery?
Yes. Many patients are managed with supportive care, steroids, or IGF-1R inhibitor therapy without ever needing surgery. Surgery is generally reserved for sight-threatening cases or for correcting residual changes, like persistent double vision or eyelid position, once the active disease has stabilized.
What are the side effects of thyroid eye disease treatment?
Side effects vary by treatment. Steroids can raise blood sugar and affect mood and sleep. IGF-1R inhibitors like veligrotug can cause infusion reactions, in about 9% of patients in trials, hyperglycemia in about 12%, and carry a risk of hearing impairment. Your doctor will monitor for these throughout treatment.
Does smoking make thyroid eye disease worse?
Yes. Cigarette smoking is the strongest modifiable risk factor for thyroid eye disease, and the risk and severity increase with the number of cigarettes smoked. Quitting smoking is one of the most effective things a patient can do to support their treatment and slow disease progression.
Sources and References:
- Pharmacy Times. FDA Approves Veligrotug-vvze as First Agent With Data in Both Active and Chronic Thyroid Eye Disease
- Ophthalmology Times. FDA approves veligrotug-vvze (Lumvoa) for thyroid eye disease across active and chronic stages
- AJMC. Treatment for Thyroid Eye Disease Approved by FDA
- MedCentral. FDA Approves Veligrotug, Expanding Treatment Options for Thyroid Eye Disease
- Viridian Therapeutics. Viridian Therapeutics Announces U.S. FDA Approval and Launch of Lumvoa (veligrotug-vvze) for the Treatment of Thyroid Eye Disease
- HCPLive. FDA Approves Veligrotug-vvze for Thyroid Eye Disease
- Cleveland Clinic. Thyroid Eye Disease (Graves’ Eye Disease)
- CheckRare. FDA Approves Lumvoa (Veligrotug) for Thyroid Eye Disease
This article is for informational purposes only and is not a substitute for professional medical advice. Always consult your endocrinologist or ophthalmologist for diagnosis and treatment decisions specific to your condition.
Medically reviewed by
This guide was checked for medical accuracy by our review board before publishing.
Dr. Praveen Verma, MBBS, MD (Pathology), Pathologist and Clinical Laboratory Specialist.
Dr. Himanshu Morya, MBBS, Medical Educator.
About the author
Iraphan Khan, BSN, RN, D.Pharm, is the founder of RealMedVision and a Public Health Researcher who creates evidence-based health content from trusted medical sources.