New Thyroid Eye Disease Treatments in 2026: What Has Changed, and Where Thailand Stands
New thyroid eye disease treatments are drugs that block a receptor called IGF-1R. They shrink the swollen muscle and fat behind the eye, so bulging and double vision can improve. In Thailand, the intravenous form has started at King Chulalongkorn Memorial Hospital, but the cost is very high, so it is used only in carefully selected patients.
By Assoc. Prof. Dr. Preamjit Saonanon, oculoplastic ophthalmologist
What causes eye bulging in thyroid eye disease?
In thyroid eye disease (TED), the immune system mistakenly targets the tissue in the eye socket. The small muscles that move the eye and the fat behind it swell. The socket is a bony box with no spare room, so the eye is pushed forward. Doctors call this proptosis.
Common signs are bulging eyes, an upper lid that pulls up into a "staring" look, redness, grittiness, puffy lids and sometimes double vision. Most people with TED have Graves' disease, but it can happen with normal thyroid levels too. For the basics, see Thyroid Eye Disease: Why Eyes Bulge and How It Is Treated.
What could older treatments do?
Steroids have long been the main medicine. They calm inflammation well, so redness and swelling improve, but they do little for the bulging itself. Many people still needed orbital decompression, an operation that makes more room in the socket so the eye can settle back.
How do the new thyroid eye disease treatments work?
Researchers found that cells in the eye socket of people with TED carry far too many IGF-1R receptors. Think of the receptor as a switch that tells the tissue to swell and grow. The new drugs turn that switch off, so the muscle and fat can actually shrink, rather than just becoming less inflamed.
Approved in the United States
Teprotumumab (Tepezza) was the first drug in this class. It is given by IV drip every 3 weeks, 8 doses in total, and studies show benefit in both the active and the chronic phase.
Veligrotug (Lumvoa) was approved by the FDA on 26 June 2026. It is given by IV drip 5 times, 3 weeks apart, is labeled for both active and chronic disease, and also helps double vision.
In development: an under-the-skin (subcutaneous) form of teprotumumab. A 2026 phase 3 trial reported results close to the IV form, but it is not yet approved.
Side effects to know about
These drugs are not right for everyone. Side effects your doctor will monitor include:
Reduced hearing or ringing in the ears, which can occasionally be permanent
Raised blood sugar, so extra care is needed with diabetes
Flare-ups of inflammatory bowel disease
Muscle cramps, tiredness and reactions during the drip
They must not be used in pregnancy
In some people, symptoms can return after treatment ends, so ongoing follow-up matters.
Are these treatments available in Thailand?
In Thailand, the intravenous form of this drug class has started at King Chulalongkorn Memorial Hospital. It is in an evaluation phase, with doctors collecting treatment results from Thai patients.
Because the drug is very expensive, patients are selected with care, for example those with moderate to severe bulging or double vision. The results gathered will help set treatment standards suited to Thai patients in the future.
People with milder disease still have good options: stable thyroid control, stopping smoking, lubricating eye drops, or eyelid surgery once the disease has settled.
Frequently asked questions
Do these drugs mean I won't need surgery?
They can lower the chance of needing orbital decompression for many people, but some still need eyelid or eye muscle surgery later. Your doctor will assess this case by case.
Can long-standing thyroid eye disease still be treated with these drugs?
Newer studies show this drug class can help in the chronic phase too, but you need an examination first to see whether it suits you.
When should I see an eye doctor?
If you have a thyroid condition and your eyes bulge more, look staring, see double, or stay red and irritated. Seek care right away if your vision blurs or colors look washed out.
Book a consultation with Assoc. Prof. Dr. Preamjit Saonanon in Thong Lo, Bangkok
Treating thyroid eye disease depends on the phase, the severity and your overall health. If you have symptoms, an examination with the doctor first will help you find the option that fits you.
Clinic hours: Thursday 16:00–20:00 and Saturday 09:00–20:00 (by appointment)
This article is general information and does not replace a medical examination. Results vary from person to person.
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