Thyroid Eye Disease (TED) FAQs

TED is an autoimmune condition that occurs when your body’s immune system attacks the tissue behind your eyes by mistake. This causes the fat and muscle tissues around and behind your eyes to become inflamed, swollen, and possibly painful. Watch this video to learn more.

The swelling can also cause your eyes to push forward, or bulge, and prevent your eyelids from closing completely. You may also have other symptoms such as dry/gritty eyes, watery eyes, eye pain, and double vision. Learn how TEPEZZA can treat multiple TED symptoms.

To see how TEPEZZA may treat symptoms like these, click here.

While no one knows exactly why some people develop TED and others don’t, there are certain risk factors that may make you more likely to develop TED.

TED and Graves’ disease are both autoimmune diseases. Normally, the immune system can tell the difference between your cells and foreign cells, like bacteria. But with an autoimmune disease, the immune system attacks healthy parts of your body by mistake.

With Graves’ disease, the immune system attacks the thyroid. In TED, the immune system attacks the muscle and fat tissue behind the eyes.

Because Graves’ disease and TED attack different parts of the body, they need different treatments. Treatment for Graves’ disease won’t work for TED. TEPEZZA is the first FDA-approved treatment for TED.

Normally, your immune system can tell the difference between healthy cells and foreign cells, like bacteria. An autoimmune disease is a condition where your immune system mistakenly attacks healthy parts of the body. Autoimmune diseases are chronic, or lifelong, conditions. There are more than 80 different autoimmune diseases.

With Thyroid Eye Disease (TED), the immune system attacks the muscle and fat tissue behind your eyes. This causes inflammation (redness and swelling) and can cause scar tissue to form. This can lead to symptoms such as bulging eyes and changes in vision.

TED is an ongoing autoimmune condition that affects the eyes and can get worse over time. With TED, your body’s immune system mistakenly attacks the tissue behind your eyes, causing inflammation and swelling of the muscle and fat tissue. This can lead to symptoms like red, dry, itchy, or watery eyes, eyelid changes, pressure or pain behind the eyes, bulging eyes, and double vision.

TED looks different for everyone. Symptoms can appear at any time and range from mild to severe. New or existing symptoms may also temporarily come back or get worse, which is called a flare. More than 1 out of 10 people with TED experience flares, regardless of how their TED was treated, and these flares can occur years after early symptoms stopped or lessened.

While your doctor may prescribe other medicines for your symptoms, TEPEZZA is the first FDA-approved medicine to treat TED. It is the first medicine designed to target a source of TED.

The exact nature of how TED develops and progresses is not entirely understood, therefore, precisely how TEPEZZA works is not fully established.

TED is an ongoing autoimmune condition, so it is possible for new symptoms to appear. If you have not had any changes in your symptoms for quite some time, and then suddenly start to see them come back, or get worse, this is called a "flare." Flares are a part of how autoimmune diseases affect the body.

Some potential events that may trigger a flare in TED are:

• Changes in thyroid levels
• Pregnancy
• Stress
• Eye surgeries such as cataract removal, strabismus repair, decompression, and lid surgery

Since there may be other unknown causes of a TED flare, it is important to speak with your TED Specialist about any concerns you may have about changing medicines or starting a new medicine, getting pregnant, taking a vaccine, or having any surgery. This is important to do before, during, or after your treatment for TED.

About 1 out of 6 TED patients may have flares, regardless of how their TED was treated. Sometimes these flares are years after early symptoms stopped or lessened.

TED is an ongoing autoimmune condition, so it is possible for new symptoms to appear. If you have not had any changes in your symptoms for quite some time, and then suddenly start to see them come back, or get worse, this is called a "flare." Flares are a part of how autoimmune diseases affect the body.

Some potential events that may trigger a flare in TED are:

• Smoking: People who smoke are up to 8 times more likely to develop TED. Smoking can also make TED worse and treatment may not work as well
• Gender: Women are 5 times more likely than men to develop TED
• Age: TED occurs more often in people who are 50 years or older
• Radioactive iodine: This is a medicine used to treat Graves’ disease. It can increase the chances of getting TED and can make TED worse
• Thyroid problems: Graves’ disease and other thyroid conditions, such as Hashimoto’s disease and hyperthyroidism, are known risk factors for TED
• Family history: Thyroid conditions often run in families. If a family member develops a condition that affects his or her thyroid, you may be at an increased risk for developing one too. Having a thyroid condition puts you at higher risk of developing TED

Learn about the symptoms of TED.

Thyroid Eye Disease (TED) can cause swelling behind the eye, which can make the eyes bulge. With TED, muscle and fat tissue behind the eye become inflamed (red and swollen). This swelling pushes on the back of the eye, causing it to bulge forward. Your doctor may also call this proptosis (prop-toe-sis) or exophthalmos (ek-sof-thal-muhs).

Watch this video to learn why eyes bulge and how TEPEZZA can help.

Dietary supplements or vitamins are not recognized by the FDA to treat any disease. Talk to your doctor if you have additional questions.

Double vision, also known as diplopia (dih-ploh-pee-uh), is when you see 2 images of an object instead of 1. Images can appear side-by-side, one on top of the other, or a mix.

If you have a thyroid condition such as Graves' disease, there is a chance you may also develop a separate condition called Thyroid Eye Disease (TED). Up to 40% of people diagnosed with Graves’ disease could develop TED.

Although Graves' disease and TED are both autoimmune conditions, they affect different parts of the body. Graves' disease affects the thyroid gland, while TED affects the eyes.

TED can cause muscles and fat behind the eye to become swollen. Inflammation of the muscles and fat can cause the eyes to point in different directions and make them hard to move. Your doctor may refer to this as strabismus.

Since the eyes may be pointing in different directions, it is harder for them to focus on a single object at the same time. So one object is seen as two.

Because Graves' disease and TED are different conditions, they require different treatments. Treatment for Graves’ disease won’t work for TED, and treatment for TED won’t work for Graves’ disease. This is why it is important to ask your doctor about a treatment for TED, like TEPEZZA.

Learn how TEPEZZA may help treat double vision caused by TED.

While not all people with Thyroid Eye Disease (TED) will get double vision, those who do may have different types. Some people have double vision all the time (constant). Other people may have double vision that comes and goes. “Temporary” and “situational” double vision can come and go, and are caused by TED. Watch the videos below to see how these different types of double vision may appear.

• Temporary: When waking up in the morning or when tired
• Situational: When looking to the left or right or toward the corners of the eyes
• Constant: Always noticeable

Learn about the other symptoms of TED.

There isn’t one “first symptom” of TED. TED looks different for everyone, and the earliest signs vary from person to person. Some people may notice changes in how their eyes look, while others may first experience changes in how their eyes feel or function.

Some of the common symptoms of TED include:

TED symptoms can change over time and may include eye bulging, double vision, or pressure behind the eyes. Tracking your symptoms and talking with your doctor can help guide conversations about your care, and treatment may help reduce the impact TED has on your day-to-day life.

Read more about the symptoms of TED.

Your doctor can help you decide if TEPEZZA is right for you. TEPEZZA, the first FDA-approved medicine to treat TED, can help no matter if you’ve had TED for months or years. TEPEZZA is a non-surgical, infusion medicine proven to provide multi-symptom relief:

In a clinical study, more than 8 out of 10 people taking TEPEZZA saw reduced eye bulging vs 1 out of 10 people taking placebo.

Throughout 24 weeks, this study followed patients taking TEPEZZA who were recently diagnosed with moderate-to-severe TED.
Eye bulging was reduced by at least 2 mm.

In clinical studies, 2 out of 3 people who completed treatment with TEPEZZA had little to no eye pain (including pain behind the eye and when moving the eye), redness of the eye/eyelid, and swelling of the eye/eyelid.

In combined results from two studies, TED patients’ levels of inflammation were recorded using their Clinical Activity Score (CAS), which is a tool that doctors use to assess their patients’ TED symptoms. It evaluates for the presence of 7 symptoms in the eyes and surrounding area: pain that happens for no apparent reason; pain due to looking at something for too long; eyelid swelling; eyelid redness; redness of the eye itself; swelling of the eye, and inflammation in the inner corner of the eye. The higher the CAS number (from 0 to 7), the more serious the impact of TED is seen to be. In patients with a CAS of at least 4 at the start of treatment, by the end of treatment 62% (52 of 84) of those treated with TEPEZZA had a CAS of 0 or 1 (seen as inactive disease state) compared to 22% (18 of 87) of those who were treated with placebo. Each of the 7 symptoms is counted equally toward a single overall score, even though that may not reflect their impact to the individual patient. For example, if a patient has eye redness and eye pain, but is only really bothered by the eye pain, each symptom still adds to the overall score by 1.

Your doctor can help you decide if TEPEZZA is right for you. Whether you’re newly diagnosed or have had Thyroid Eye Disease (TED) for years, TEPEZZA is an infusion medicine proven to reduce eye bulging and help TED patients look more like themselves again.

In a clinical study, more than 8 out of 10 people taking TEPEZZA saw reduced eye bulging vs 1 out of 10 people taking placebo.

Throughout 24 weeks, this study followed patients taking TEPEZZA who were recently diagnosed with moderate-to-severe TED.
Eye bulging was reduced by at least 2 mm.

Not all eye doctors are used to treating TED, which is why seeing a TED Specialist can be an important step in your care.

Find a TED Specialist near you.

Out-of-pocket costs vary depending on your health insurance plan. Amgen By Your Side, a patient support program, is available to help you explore available financial support options.

• Do you have commercial insurance, such as a preferred provider organization (PPO) or health maintenance organization (HMO)? Eligible commercially insured patients may pay as little as $0 out-of-pocket for each dose through the Amgen Commercial Co-Pay Program*
• Do you have government insurance, such as Medicare, Medicare Part D, Medicaid, Medigap, VA, CHAMPUS, Department of Defense, TRICARE, or any state patient, foundation, or other pharmaceutical program? If so, there may be other support for you
• No insurance? You still may have options for treatment coverage

Once you and your doctor decide TEPEZZA is right for you, our Amgen By Your Side staff is available to talk you through the insurance approval process.

*Eligibility criteria and program maximums apply. Click here for full terms and conditions. Patients who are residents of Massachusetts or Rhode Island are not eligible for administration support.

Coverage for TEPEZZA varies depending on your health insurance plan.

• If you have commercial insurance, such as a preferred provider organization (PPO) or health maintenance organization (HMO), you may be eligible to pay as little as $0 out-of-pocket for both the cost of TEPEZZA and the IV infusion process through the Amgen Commercial Co-Pay Program*
• If you have government insurance such as Medicare, Medicare Part D, Medicaid, Medigap, VA, CHAMPUS, Department of Defense, or TRICARE, other support may be available.

Once you and your doctor decide TEPEZZA is right for you, our Amgen By Your Side staff is available to talk you through the insurance approval process.

*Eligibility criteria and program maximums apply. Click here for full terms and conditions.
Patients who are residents of Massachusetts or Rhode Island are not eligible for administration support.

Coverage for patients with Medicare, Medicare Part D, Medicaid, Medigap, VA, CHAMPUS, Department of Defense, or TRICARE varies by state and individual. Once you and your doctor decide TEPEZZA is right for you, our Amgen By Your Side staff are available to review the insurance approval process.

Over 25,000 Thyroid Eye Disease (TED) patients have been treated with TEPEZZA.^†

^†Based on 25,062 individual patients enrolled in Amgen By Your Side who received at least one dose of TEPEZZA from 02/05/2020 - 11/14/2025. TED diagnosis is assumed based on initiation of TEPEZZA.

The most common side effects of TEPEZZA include muscle cramps or spasms, nausea, hair loss, diarrhea, feeling tired, high blood sugar, hearing problems, taste changes, headache, dry skin, weight loss, nail problems, inflammatory bowel disease, infusion reactions, and changes in menstruation. Learn more about potential TEPEZZA side effects. Then watch a video from a TED Specialist about side effects.

Always speak with your doctor about any side effects you may be experiencing.

TEPEZZA is an IV (intravenous) medicine. This means it is delivered through a needle that is placed in your arm. The process of delivering an IV medicine is called an infusion.

TEPEZZA is given as 1 infusion every 3 weeks, for a total of 8 infusions. So, completing TEPEZZA treatment takes about 5 months.

Your first and second infusions of TEPEZZA will last about 90 minutes each. Your remaining 6 infusions will take about 60 minutes each, but could be longer depending on how you react to the infusion.

Even if you see early improvement, it is important to complete all 8 infusions to maximize your experience with TEPEZZA.

You may receive TEPEZZA at an infusion center. This is a clinic that specializes in delivering IV medicines like TEPEZZA. You may also receive TEPEZZA in your doctor’s office, in a hospital, or in your own home. Talk to your doctor and your insurance provider about the right location for you.

Typically, you’ll receive your TEPEZZA in an infusion chair, which is a cushioned armchair a lot like a recliner.

There may be a TV to help you pass the time, or you can enjoy your own books, magazines, or your tablet or phone. There may be other patients nearby receiving medicines for many types of conditions, not just Thyroid Eye Disease (TED). Medical professionals, like nurses, at the infusion center are trained to look out for side effects, such as infusion reactions, and know how to handle them. They are also trained on the proper way to give IV medicines.

The first 2 infusions of TEPEZZA will take about 90 minutes each to complete. Depending on how you react to the medicine, the next 6 infusions may be as short as 60 minutes. But taking into account time to check-in, have your vitals checked, and prepare the infusion, the total time will be longer.

See how one patient talks about her TEPEZZA infusion experience.

While TEPEZZA and some chemotherapy treatments are both infusions, they are not the same type of medicine.

There are many kinds of medicines that are infused to treat a variety of conditions. And infused medicines may be more common than you think; in fact, some antibiotics are infused. Infusions are also used to treat autoimmune conditions like Thyroid Eye Disease (TED), psoriasis, rheumatoid arthritis, inflammatory bowel disease (IBD), and others.

See how one patient talks about her TEPEZZA infusion experience.

For some people in clinical studies, TEPEZZA worked quickly: some people began to see less eye bulging in as soon as 6 weeks (after 2 infusions). TEPEZZA took longer to work for some patients. It is important to know that in clinical studies, the eye bulging for people who saw results with TEPEZZA continued to get better through the full course of 8 infusions.

See real before/after photos.

The TEPEZZA clinical studies were designed for patients to receive 8 infusions.

In a clinical study of recently diagnosed patients, more than 8 out of 10 patients who completed all 8 infusions of TEPEZZA had less eye bulging. Additionally, 7 out of 10 patients in the clinical studies had improvements in double vision. Patients also had less eye redness, pain, and swelling.

To see how TEPEZZA may treat symptoms like these, click here.

You may start to see some results with TEPEZZA before all 8 infusions are complete. But TEPEZZA was designed and tested as a course of 8 infusions, so you should finish all infusions as prescribed by your doctor.

You should not take TEPEZZA if you are pregnant because TEPEZZA may harm your unborn baby. Be sure to tell your doctor if you are pregnant or plan to become pregnant. If you can become pregnant, you should use an effective form of birth control (contraception) before you start TEPEZZA, during treatment, and for at least 6 months after your last TEPEZZA treatment.

Before receiving TEPEZZA, tell your doctor if you are breastfeeding or plan to breastfeed. It is not known if TEPEZZA passes into your breast milk. Talk to your doctor about the best ways to feed your baby during treatment with TEPEZZA.

In clinical studies, some patients experienced hearing impairment. While hearing loss was a side effect experienced with TEPEZZA, “hearing impairment” also refers to different types of less severe hearing problems. The types of hearing impairment events patients in the TEPEZZA clinical studies experienced were:

• Hyperacusis: becoming more sensitive to sounds, with some noises being painfully loud
• Eustachian tube dysfunction: 1 or both ears feel like they are plugged with fluid
• Hearing loss or deafness: a partial or total inability to hear sounds
• Hypoacusis: a general term for hearing loss that can affect 1 or both ears. With hypoacusis, a person can still hear, but not as well as they usually can
• Autophony: when it sounds like your own voice is too loud or echoing in your ears
• Tinnitus: a ringing or buzzing sound in 1 or both ears

Watch this video to learn more about changes in hearing experienced in clinical studies, as well as the relationship between Thyroid Eye Disease (TED) and hearing issues.

Always speak with your doctor about any side effects you may be experiencing.

Read more about the symptoms of TED.

TEPEZZA is a non-surgical treatment option for Thyroid Eye Disease (TED), and can be used no matter if you’ve had TED for months or years.

TEPEZZA was designed to target a root cause of TED. TEPEZZA was designed to block the body’s response to this autoimmune condition that can cause 1 or more of the following signs and symptoms: pain, redness, swelling, pressure behind the eyes, bulging, watery eyes, and more.

Every treatment is different, so you should talk to your doctor about potential side effects. The most common side effects of TEPEZZA include muscle cramps or spasms, nausea, hair loss, diarrhea, feeling tired, high blood sugar, hearing problems, taste changes, headache, dry skin, weight loss, nail problems, and changes in menstruation. Learn more about potential TEPEZZA side effects. Then watch a video from a TED Specialist about side effects.

Always speak with your doctor about any side effects you may be experiencing.

Out-of-pocket costs for TEPEZZA vary depending on your health insurance plan. Amgen By Your Side, a patient support program, is available to help you explore available financial support options.

• Do you have commercial insurance, such as a preferred provider organization (PPO) or health maintenance organization (HMO)? Eligible commercially insured patients may pay as little as $0 out-of-pocket for each dose through the Amgen Commercial Co-Pay Program*
• Do you have government insurance, such as Medicare, Medicare Part D, Medicaid, Medigap, VA, CHAMPUS, Department of Defense, TRICARE, or any state patient, foundation, or other pharmaceutical program? If so, there may be other support for you
• No insurance? You still may have options for treatment coverage

Once you and your doctor decide TEPEZZA is right for you, our Amgen By Your Side staff is available to talk you through the insurance approval process and what your potential out-of-pocket treatment costs may be.

*Eligibility criteria and program maximums apply. Click here for full terms and conditions. Patients who are residents of Massachusetts or Rhode Island are not eligible for administration support.