Thyroid Eye Disease (TED), a significant complication of Graves' disease, involves complex autoimmune mechanisms, including overexpression of TSH receptors (TSHR) and IGF-1 receptors on orbital fibroblasts, leading to inflammation and tissue expansion. Current treatments include glucocorticoids, which are effective in early disease but have significant side effects. Newer biological therapies, such as Teprotumumab, target specific pathways and show improved efficacy with fewer side effects. Future research aims to personalize treatment based on disease severity and patient response. Challenges include long-term safety, variability in treatment response, and the need for more effective therapies. Emerging treatments include biosimilars, small molecule inhibitors, and TSHR blockers, which may offer better outcomes. Despite progress, challenges remain in ensuring equitable access to these therapies across healthcare systems.Thyroid Eye Disease (TED), a significant complication of Graves' disease, involves complex autoimmune mechanisms, including overexpression of TSH receptors (TSHR) and IGF-1 receptors on orbital fibroblasts, leading to inflammation and tissue expansion. Current treatments include glucocorticoids, which are effective in early disease but have significant side effects. Newer biological therapies, such as Teprotumumab, target specific pathways and show improved efficacy with fewer side effects. Future research aims to personalize treatment based on disease severity and patient response. Challenges include long-term safety, variability in treatment response, and the need for more effective therapies. Emerging treatments include biosimilars, small molecule inhibitors, and TSHR blockers, which may offer better outcomes. Despite progress, challenges remain in ensuring equitable access to these therapies across healthcare systems.