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Medical treatment in thyroid eye disease in 2020
  1. Jwu Jin Khong1,2,3,
  2. Alan McNab1,2
  1. 1 Department of Surgery, University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, Victoria, Australia
  2. 2 Orbital Plastics and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
  3. 3 Department of Ophthalmology, Austin Health, Heidelberg, VIC, Australia
  1. Correspondence to Dr Jwu Jin Khong, Department of Surgery, University of Melbourne, Centre for Eye Research Australia Ltd, East Melbourne, VIC 3002, Australia; jwujinkhong{at}


Thyroid eye disease (TED) affects 25% of patients with Graves’ hyperthyroidism, where 1 in 20 patients has active, moderate-to-severe disease that will require medical treatment for reducing TED activity and severity. Intravenous corticosteroid has been the mainstay of treatment for active moderate-to-severe TED. With improved understanding of the pathophysiology of TED, immunotherapy targeting different molecular pathways including T cells, B cells, cytokines and cell surface receptors have been investigated in randomised clinical trials. This review provides an overview of the current advances in medical treatment including teprotumumab, tocilizumab, rituximab and mycophenolate and the indications for their use in the management of active, moderate-to-severe TED.

  • orbit
  • treatment medical
  • drugs

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  • Contributors JJK is involved in the conception of review, literature analysis and synthesis, preparation of manuscript, critically revising the manuscript and responding to reviewers. AM critically appraised and edited the manuscript for the entire content, and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.