Teprotumumab (Tepezza)

The first FDA-approved medication specifically for thyroid eye disease, targeting IGF-1 receptor.

Drug Class: biologic

Teprotumumab (brand name Tepezza) is a monoclonal antibody that blocks the insulin-like growth factor-1 receptor (IGF-1R). It's the first medication specifically approved for thyroid eye disease (TED) and can reduce proptosis (bulging eyes) and inflammation.

Key Takeaways

First FDA-approved drug specifically for TED
Reduces proptosis (bulging eyes) and inflammation
Given as IV infusion over 8 sessions
Most effective in active disease
Expensive—insurance coverage may be needed

How It Works

In thyroid eye disease, antibodies that cause Graves' disease also activate the IGF-1 receptor in orbital tissue, leading to inflammation and tissue expansion. Teprotumumab blocks this receptor, reducing inflammation and allowing the eye to return toward normal position.

Common Uses

Thyroid eye disease—moderate to severe, active phase
Reduces proptosis, double vision, and inflammation

For comprehensive information about managing TED, including when teprotumumab is appropriate, the surgical rehabilitation pathway, and why smoking cessation is critical, see our guide: Thyroid Eye Disease - Active Treatment and Rehabilitation Guide.

Administration

8 IV infusions over 24 weeks
Infusions every 3 weeks
Given in infusion center
First infusion takes about 90 minutes; later ones about 60 minutes

Expected Benefits

Reduction in proptosis (eye bulging)—average 2-3mm
Improvement in double vision
Reduction in orbital inflammation
May reduce need for surgery

Side Effects

Common

Muscle spasms or cramps
Nausea
Hair loss (usually temporary)
Diarrhea
Fatigue
Dry skin

Serious

Hearing problems (may be permanent in some cases)
Elevated blood sugar
Infusion reactions

Important Considerations

Hearing changes: Some patients have experienced hearing loss or other hearing problems that may not fully resolve. Report any hearing changes to your doctor immediately.

Before Starting

Hearing test (audiogram) recommended
Blood sugar monitoring (especially diabetics)
Pregnancy testing (not safe in pregnancy)

Cost Considerations

Teprotumumab is expensive. Most patients require insurance approval, and manufacturer assistance programs may help with costs.

Frequently Asked Questions

Will my eyes go back to normal?

Teprotumumab reduces proptosis significantly in most patients, but eyes may not return completely to pre-disease appearance. Additional surgery may still be needed in some cases.

Does it help double vision?

Yes, many patients see improvement in double vision, likely due to reduced muscle inflammation and improved alignment.

What happens after the 8 infusions?

Many patients have lasting improvement. Some may experience recurrence and need additional treatment. Long-term data is still being collected.

Medically Reviewed Content

This article meets our editorial standards

Written by:: Hashemi Eye Care Medical Team
Medically reviewed by:: Board-Certified Neuro-Ophthalmologist (MD, Neuro-Ophthalmology)
Last reviewed:: January 30, 2025

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