This review provides an overview of the current understanding of Thyroid Eye Disease (TED) and its pathophysiology, describes the evidence base for current treatment recommendations, and discusses newer biological therapies and future therapeutic research. TED is a significant disease burden affecting 25-50% of patients with Graves' disease, causing orbital inflammation and tissue expansion. The pathophysiology involves autoimmune dysfunction, with overexpression of TSH-Receptors (TSHR) leading to adipogenesis and increased orbital adipose tissue. Recent targeted therapies, such as Teprotumumab, have shown promise by focusing on specific molecular pathways. Future challenges include identifying the most effective targets for each patient and addressing long-term safety profiles. The review also covers early recognition, diagnosis, and current management strategies, including glucocorticoids, second-line immunosuppressive treatments, orbital radiotherapy, and non-immunosuppressive adjunct therapies. The development of future therapies, such as biosimilar and small molecule IGFR-1 receptor blockers, is discussed, highlighting the need for personalized treatment approaches.This review provides an overview of the current understanding of Thyroid Eye Disease (TED) and its pathophysiology, describes the evidence base for current treatment recommendations, and discusses newer biological therapies and future therapeutic research. TED is a significant disease burden affecting 25-50% of patients with Graves' disease, causing orbital inflammation and tissue expansion. The pathophysiology involves autoimmune dysfunction, with overexpression of TSH-Receptors (TSHR) leading to adipogenesis and increased orbital adipose tissue. Recent targeted therapies, such as Teprotumumab, have shown promise by focusing on specific molecular pathways. Future challenges include identifying the most effective targets for each patient and addressing long-term safety profiles. The review also covers early recognition, diagnosis, and current management strategies, including glucocorticoids, second-line immunosuppressive treatments, orbital radiotherapy, and non-immunosuppressive adjunct therapies. The development of future therapies, such as biosimilar and small molecule IGFR-1 receptor blockers, is discussed, highlighting the need for personalized treatment approaches.