The role of disease-modifying antirheumatic drugs (DMARDs) in the management of thyroid eye disease (TED) is evolving. While corticosteroids remain the most widely used first-line treatment worldwide, their significant side effects and limitations in long term use make alternative and adjunctive approaches desirable. DMARDs offer a steroid-sparing strategy by modulating the immune system. This chapter details the mechanisms, efficacy, and safety profiles of various DMARDs used in TED, along with considerations for pre-treatment screening and monitoring. It evaluates the role DMARDs may play in formulating effective and personalised treatment strategies. Future considerations include the potential for integration with biologic therapies, a strategy which is used in other autoimmune conditions. Further research Is necessary to refine the role of DMARDs within the evolving management paradigm of TED.