Hearing Loss Risks Associated With Tepezza

The approval of Tepezza® (teprotumumab) has been a major advancement in the treatment of thyroid eye disease (TED) (1). As the first FDA-approved medication specifically for TED, it has helped many patients experience meaningful improvements in eye bulging, pain, inflammation, and quality of life. As with all effective medications, however, Tepezza can have certain side effects and one of the most discussed is its potential impact on hearing.

Understanding the hearing-related risks associated with Tepezza, who is most vulnerable, and how careful monitoring can reduce long-term problems are essential for patients considering or under its treatment. Importantly, emerging research shows that most hearing changes are temporary and often return to baseline, especially when patients are appropriately screened and monitored (2).

Why Might Tepezza Cause Changes in Hearing?

Tepezza works by blocking the insulin-like growth factor-1 receptor (IGF-1R), a key driver of inflammation and tissue expansion in TED. While this mechanism of action works highly effectively for the eyes, IGF-1 signaling also has important roles in other parts of the body, including the inner ear. Within the context of hearing and the inner ear, IGF-1 is involved in cochlear hair cell survival, auditory nerve signaling and inner ear repair mechanisms. Due to this association, there is a plausible effect of Tepezza use on hearing.

What the Research Shows About Hearing Loss Risk

One of the most important studies examining the hearing effects of Tepezza was a multicenter analysis of patients treated for TED (3). This study highlighted several key findings that helped shift clinical practice toward proactive audiologic screening rather than reactive management. Some of the important conclusions from this study are:

• Hearing-related adverse events (AEs) were observed in a subset of patients
• Symptoms included muffled hearing, tinnitus (ringing), ear fullness, or changes on audiometry
• Patients with pre-existing hearing loss were at higher risk of developing measurable hearing changes
• The study also emphasized the importance of baseline hearing evaluation and ongoing monitoring

Another landmark prospective study examining audiometry outcomes followed 52 patients treated with Tepezza and provides some of the most reassuring data available (2). The key findings demonstrated that:

• The majority of patients who experienced hearing changes showed improvement by the 6-month follow-up period
• Long-term hearing loss in patients with normal baseline hearing was rare, with an incidence of approximately 3%
• Patients with baseline hearing dysfunction were significantly more likely to experience persistent deficits
• The study reinforced that baseline audiometry is critical for risk stratification

The authors also explored the biological plausibility of IGF-1R involvement in inner ear function, noting that while a link is likely, further research is needed to establish a definitive causal relationship.

Another study examining patients with long-standing, less active TED primarily focused on the efficacy of Tepezza in mitigating TED symptoms but it also reported safety outcomes regarding hearing, such as:

• A small number of patients reported hearing-related adverse events
• Most hearing symptoms improved or resolved during follow-up
• No widespread signal of permanent hearing loss was observed in patients without baseline dysfunction

Although side effects on hearing were not the primary focus of this study, its findings support the broader conclusion that many hearing effects are reversible.

Which Patients are at a Higher Risk for Hearing Changes?

Based on current evidence, patients at higher risk include:

• Those with pre-existing hearing loss, even if mild
• Patients with a history of:
• Chronic ear disease
• Noise-induced hearing loss
• Age-related hearing decline
• Individuals with an abnormal baseline audiometry before starting Tepezza

Importantly, patients with normal baseline hearing have a low risk of permanent hearing loss, especially when appropriately monitored. Hence, baseline testing for auditory issues is an important precursor for patient stratification if Tepezza is to be considered.

Why Baseline and Ongoing Hearing Testing Matters

As discussed above, a key takeaway from the current body of research is that careful monitoring of Tepezza use and regular audiologic testing are vital components of the treatment protocol. Hence at Dr. Douglas’s office, we follow a proactive monitoring protocol where hearing safety is paramount and is treated as a core part of patient care and not an afterthought. Our protocol includes:

• Baseline hearing testing before starting Tepezza
• Repeat audiologic testing multiple times during the treatment course
• Continued hearing evaluations at all follow-up visits for up to 1 year after treatment
• Clear criteria for identifying concerning changes in audiometry
• Immediate referral to an audiologist for further testing and management if changes meet referral thresholds

This approach strongly aligns with the recommendations suggested by emerging clinical studies concerning Tepezza use for TED management.

What Symptoms Can Be Common?

Even with routine testing and as it is with any new medication regimen, patients should promptly report any new or changing symptoms, including:

• Muffled or reduced hearing
• Ringing or buzzing in the ears (tinnitus)
• A feeling of ear fullness or pressure
• Difficulty understanding speech, especially in noisy environments
• Sudden changes in one or both ears

Early reporting is crucial as it allows for timely evaluation and, when needed, adjustment of treatment plans.

Are Hearing Changes Permanent?

For most patients, no. Across studies:

• The majority of hearing changes improved by the end of treatment or resolved after treatment
• Long-term hearing loss was uncommon, particularly in patients with normal baseline hearing
• Persistent deficits were more likely in patients who already had hearing impairment before starting therapy

This is why baseline testing is so important: it helps distinguish new drug-related changes from pre-existing conditions and guides decision-making. It’s also important to go to a center that can track your progress and notice changes immediately.

Balancing Benefits and Risks

Given these concerns, it is also important to put the hearing risks with Tepezza usage in context. This is because Tepezza has been clinically shown to:

• Significantly reduce proptosis (eye bulging)
• Improve double vision and pain
• Decrease inflammation
• Improve the quality of life in many patients with moderate to severe TED

For patients at risk of vision loss, optic nerve damage or severe disfigurement, the benefits of treatment may outweigh the relatively low risk of hearing-related side effects, particularly when careful monitoring is in place. Shared decision-making guided by baseline testing, ongoing monitoring, and patient values is key.

What Patients Can Do to Reduce Risk

If you are considering or receiving Tepezza, you can help protect your hearing by:

• Completing baseline audiometry before treatment
• Attending all scheduled hearing tests before, during and after therapy
• Reporting symptoms early, even if they seem mild
• Avoiding additional hearing stressors (e.g., loud noise exposure) during treatment
• Following through with audiology referrals if recommended

Safely Explore Tepezza Treatment With Expert Guidance

While concerns about hearing loss with Tepezza are valid, they should be seen in the light of current evidence. Research shows that:

• Hearing changes can occur, and if/when they occur, they are particularly in patients with baseline hearing loss
• Most hearing effects are temporary or improve over time
• Permanent hearing loss in patients with normal baseline hearing is rare (≈3%)
• Baseline and ongoing audiologic monitoring dramatically improve safety

At Dr. Douglas’s office, hearing health is integrated into every stage of Tepezza care from the first visit through long-term follow-up so patients can pursue treatment with confidence and clarity. If you are considering Tepezza and have concerns about hearing, discuss them openly with your care team and do not hesitate to schedule an appointment with Dr. Raymond Douglas. With the right screening, monitoring, and follow-up, Tepezza can be used safely and effectively in many patients with thyroid eye disease.

References

1. Couch, S. M. Teprotumumab (Tepezza) for Thyroid Eye Disease. Mo Med 119, 36-41 (2022). 
2. Hori, K., Wenger, T., Davuluru, S., Zhang-Nunes, S. & Choi, J. S. Otologic Symptoms in Patients Treated With Teprotumumab: A Multi-Institutional National Cohort Study. Laryngoscope 136, 395-402 (2026). https://doi.org/10.1002/lary.700453 Shah, S. A.et al.
3. Teprotumumab-Related Adverse Events in Thyroid Eye Disease: A Multicenter Study. Ophthalmology131, 458-467 (2024). https://doi.org/10.1016/j.ophtha.2023.10.018