Treatment Pathways: Diagnosis to Options

Sean Paul outlines initial assessment, inflammatory versus quiet disease, and general treatment categories including steroids and radiation.

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What if the reason thyroid eye disease feels so confusing is because it requires more than one specialist to treat it well?

In this episode of Modern Thyroid and Wellness, host McCall McPherson sits down with Dr. Sean Paul, a board-certified oculoplastic and orbital surgeon based in Austin, Texas, to explore thyroid eye disease (TED) from diagnosis through advanced treatment.

Dr. Paul explains what thyroid eye disease really is, why it is often underdiagnosed, and how it impacts both vision and quality of life. The conversation covers medical therapy, biologic treatments like Tepezza (teprotumumab), surgical options, and the importance of a multidisciplinary approach. They also discuss emerging trends in aesthetic and reconstructive eye surgery, regenerative skin treatments, and why long-term maintenance and skin health matter just as much as procedures.

This episode offers clarity, hope, and practical guidance for anyone struggling with thyroid eye disease, Graves’ disease, or eye changes related to autoimmune thyroid conditions.

👤 About the Guest: Dr. Sean Paul

Dr. Sean Paul is a fellowship-trained oculoplastic and orbital surgeon and the founder of Austin Face and Body. He completed medical school in San Antonio and trained extensively in ophthalmology and oculoplastic surgery, with early experience in reconstructive eye surgery at Brooke Army Medical Center during Operation Iraqi Freedom.

Dr. Paul specializes in thyroid eye disease, orbital inflammation, eyelid reconstruction, and aesthetic facial surgery, blending functional restoration with natural-appearing cosmetic outcomes. His practice focuses on both medical necessity and patient confidence.

🔑 Key Topics Covered

What thyroid eye disease is and why it is an autoimmune orbital inflammatory condition
The connection between TED and Graves’ disease, hyperthyroidism, and hypothyroidism
Early and subtle symptoms of thyroid eye disease, including dryness, redness, eyelid asymmetry, and double vision
Why thyroid eye disease is frequently underdiagnosed
The difference between active inflammatory disease and “quiet” or chronic disease
The emotional and social impact of eye changes in Graves’ disease
How oculoplastic and orbital surgeons are trained and what makes them different from general ophthalmologists
Medical treatment options including steroids, radiation, and biologic therapy
Tepezza (teprotumumab): how it works, how it is administered, and potential side effects including hearing changes
Surgical options for thyroid eye disease:
Orbital decompression (fat and bone)
Strabismus (eye muscle) surgery
Eyelid retraction repair
Typical recovery timelines and why disease stability matters before surgery
The role of inflammation control, thyroid antibodies, and IGF-1 receptor pathways
Cosmetic and reconstructive trends in eyelid and facial surgery
Why “natural” results and long-term maintenance are now the standard
The growing role of regenerative treatments, lasers, and skin health in facial rejuvenation

🧠 Important Medical Clarifications (Fact-Checked)

The biologic medication discussed is Tepezza (teprotumumab), not “Topaz”
Tepezza targets the IGF-1 receptor, a key pathway involved in thyroid eye disease inflammation
Tepezza is administered intravenously over a structured infusion schedule
Hearing changes are a known side effect and require monitoring
Orbital decompression may be urgent if the optic nerve is threatened
Surgery is ideally performed after 3–6 months of disease stability, unless vision is at risk