The evolving landscape of thyroid eye disease: present and future

Thyroid eye disease (TED) is a complex ocular autoimmune disorder primarily associated with Graves' disease. It leads to significant morbidity due to orbital inflammation, fibrosis, and tissue expansion. While corticosteroids have been the traditional mainstay of therapy, recent advancements in understanding TED pathophysiology have driven the development of targeted treatments. Notably, inhibition of the insulin-like growth factor-1 receptor with teprotumumab has revolutionized TED management, demonstrating efficacy in reducing proptosis and disease severity. Additional emerging therapies, including neonatal Fc receptor inhibitors, thyroid-stimulating hormone receptor blockers, and interleukin-6 receptor antagonists, offer promising alternatives for patients with active and refractory disease. Despite these advancements, challenges remain in disease classification and outcome assessment. As the landscape of TED management continues to evolve, this review provides a comprehensive overview of current and emerging therapies for TED, critically examines gaps in disease evaluation, and highlights the evolving paradigm of patient-centered care. Future efforts should focus on optimizing therapeutic algorithms, refining risk stratification models, guiding personalized treatment, and promoting a multidisciplinary approach, which remain essential in improving outcomes and quality of life for affected individuals.