Does Tepezza cause hearing loss?
Yes, hearing loss is a known side effect of Tepezza (teprotumumab-trbw). Clinical studies have shown that hearing impairment occurs in some patients receiving this medication for thyroid eye disease (TED).
How Common Is Hearing Loss with Tepezza?
In clinical trials involving 170 patients with TED:
- 10% of patients treated with Tepezza experienced hearing impairment.
- 0% of patients receiving a placebo reported hearing issues.
Current research reveals evolving understanding of Tepezza's auditory effects. Multiple clinical studies have documented varying rates of hearing-related symptoms, with newer data suggesting higher incidence rates than initially reported in original trials.
Types of Hearing Impairment Reported:
- Hearing loss
- Eustachian tube dysfunction
- Tinnitus (ringing in the ears)
- Hyperacusis (higher sensitivity to sounds)
- Hypoacusis (lower sensitivity to sounds)
- Autophony (enhanced perception of your own voice or noises)
FDA Warning on Hearing Loss
Although Tepezza was approved in 2020, the warning about hearing impairment was added to the prescribing information by the FDA in July 2023. The warning states that in some cases hearing loss from Tepezza can be permanent.
Additional Studies on Hearing Loss and Tepezza
Research suggests that hearing impairment may be more common than initially reported:
- In a small study of 28 patients who took Tepezza, 46% of them complained of hearing symptoms after 4 infusions. Most patients reported an ear plugging sensation or muffled hearing.
- Another small study of 27 patients who took an average of 4 infusions showed that almost 82% of them developed new hearing symptoms. These symptoms included ringing in the ears, hearing loss, ear plugging, and autophony. At about 39 weeks, only 45.5% of patients who complained of hearing loss improved.
- A phase 4 study revealed 22% of patients taking Tepezza reported hearing impairment, compared to 10% placebo.
Why Does Tepezza Cause Hearing Loss?
Tepezza is an insulin-like growth factor-1 receptor (IGF-1R) inhibitor. IGF-1 helps protect inner ear hair cells from damage caused by noise and medication toxicity. By blocking IGF-1, Tepezza likely causes the ear hair cells to be more susceptible to damage. This results in hearing loss.
When Do Hearing Symptoms Typically Begin?
Most patients who experience hearing-related symptoms with Tepezza follow a predictable timeline pattern. Understanding this progression helps both patients and healthcare providers monitor for early signs.
Typical Onset Pattern:
- Pre-treatment baseline: Some thyroid eye disease patients may have existing hearing sensitivities
- Infusions 1-3: Early symptoms may be subtle and dismissed as temporary
- Infusions 4-6: Most documented cases report symptom onset during this period
- Infusions 7-8: Peak symptom development typically occurs
- Post-treatment: Some symptoms may persist or evolve after treatment completion
What Should You Do If You Experience Hearing Changes?
It’s important to weigh the risks and benefits of Tepezza before starting it. Your doctor will check your hearing before, during, and after treatment with Tepezza. If you notice any new changes in your hearing or ringing in your ears, contact your doctor right away.
References
-
Horizon Therapeutics. (2025, June 18). Safety & adverse reactions. TEPEZZA® (teprotumumab-trbw) for HCPs. Accessed on July 23, 2025 at https://www.tepezzahcp.com/about-tepezza/safety-and-adverse-reactions
-
Kossler, A., et. al. (2021). Hearing Loss and Teprotumumab. In: Journal of the Endocrine Society. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089925/
- Najjar, W, et. al. (2022). Audiologic Demonstration of Ototoxicity From Teprotumumab Treatment in a Patient With Thyroid Eye Disease. In: OTO Open. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9058351/
- Sears, C. M., et. al. (2022). Hearing Dysfunction After Treatment with Teprotumumab for Thyroid Eye Disease. In: American Journal of Ophthalmology. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9308628/
- Tepezza [package insert]. Updated July 2023. Horizon Therapeutics USA, Inc. Available from: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3e6c54a1-cefd-4a5b-a855-ab9f268b6cce
Read next
What are Monoclonal Antibodies and how do they work?
Monoclonal antibodies (mAbs) are man-made proteins that mimic the natural antibodies produced by our immune systems. Monoclonal antibodies can be formulated into medicines to treat various types of illnesses, such as cancer, rheumatoid arthritis or psoriasis.
Continue reading
How does Tepezza work, what's the mechanism of action?
Tepezza (teprotumumab) is an inhibitor of insulin-like growth factor-1 receptor (IGF-1R) used to treat Thyroid Eye Disease (TED). It is a monoclonal antibody that blocks IGF-1R activation and signaling. Tepezza decreases eye bulging (proptosis) by decreasing inflammation, preventing muscle and fat tissue remodeling, and preventing tissue expansion behind the eye. Continue reading
Tepezza before and after, what should I expect?
After treatment, Tepezza has been shown in 24-week long clinical studies to reduce the eye bulging, double vision, eye pain, redness and swelling that may occur before treatment with TED. Some patients may have improvement in symptoms as early as 6 weeks. In addition, an improvement in vision (such as reading or watching TV) and in the patient’s appearance was also seen. Continue reading
See also:
Related medical questions
- How long does it take Tepezza to work?
- How long does Tepezza stay in your system?
- Is Tepezza a chemotherapy drug?
- Is Tepezza used to treat Graves disease?
- Tepezza and COVID vaccine, what should I know?
- How is Tepezza injected and administered?
- Can Tepezza treat eye bulging and double vision?
Drug information
- Tepezza Information for Consumers
- Tepezza prescribing info & package insert (for Health Professionals)
- Side Effects of Tepezza (detailed)
- Tepezza user reviews (5)
Related support groups
- Tepezza (11 questions, 8 members)
- Thyroid Eye Disease (8 questions, 3 members)