Should teprotumumab be used in patients with active, moderate Graves thyroid eye disease in the absence of proptosis?  

Teprotumumab is NOT a benign therapy with multiple serious side effects and complications. In the setting of acute TED with significant disease, it has a place. For the average patient, there are multiple other treatments and other Biologics with fewer complications.

Proptosis is not the only manifestation of TED. Diplopia and lid retraction are a big deal, and Tepezza can help with this.

Given the drug’s side effects profile, I would not use it unless the patient’s disease failed a steroid trial. However, I defer my opinion to the ophthalmologists.

Teprotumumab has a specific role in TED, namely reversing the soft tissue expansion which manifests as proptosis, and swelling in the brow, upper, and lower lids. It does not affect "active" disease, namely, pain and pressure in the orbit, conjunctival, lid, and caruncle erythema and edema. Corticos...