Emerging Biologic Targets and Disease Heterogeneity in TED

Rapid advances in immunology are expanding the therapeutic landscape for thyroid eye disease beyond first-in-class IGF-1 receptor inhibition.

In this video, Sonalika Khachikian, MD, an endocrinologist at Monument Health Hospital in South Dakota, anticipates the development of additional IGF-1R–directed therapies with varying molecular properties and dosing schedules, noting that increased competition may broaden treatment options and improve access.

Beyond IGF-1R, Khachikian highlights alternative inflammatory pathways under investigation, including interleukin 6 inhibition and neonatal Fc receptor blockade. Drawing parallels to rheumatologic disease management, she suggests these agents may be particularly useful in patients whose disease phenotype is dominated by inflammatory symptoms rather than structural orbital changes. Such therapies may serve as adjuncts or induction strategies, though infection risk and systemic safety will require careful consideration.

She underscores the heterogeneity of TED, observing that while many patients respond durably to biologic therapy, others experience relapse or fluctuating disease activity. These patterns remain incompletely understood and were the subject of ongoing discussion at recent scientific meetings, including the American Thyroid Association. Her comments highlight the need for continued research to refine long-term management strategies.