Thyroid Eye Disease: Symptoms, Causes, and Treatment Options

This article will share an overview of Thyroid Eye Disease (TED), including common symptoms and when to seek help. Knowing this information can help you identify issues early and seek proper treatment.

What is thyroid eye disease (TED)?

Thyroid eye disease is an autoimmune disease that causes inflammation of the eye muscles and the fatty tissue behind the eyes. TED can cause the eyes to bulge or push forward, making the eyes and eyelids appear red and swollen. You may also experience symptoms such as eye dryness, discomfort, and vision changes.

You may also hear TED referred to as Graves’ orbitopathy (GO) or Graves’ eye disease (GED). This is because it is most commonly associated with an overactive thyroid gland caused by Graves’ disease. Graves’ disease occurs when the body’s immune system attacks itself by mistake. This causes thyroid damage and often causes the thyroid to over-produce thyroid hormones in response.

TED has two phases: the active or inflammatory phase and the stable phase. The active phase may last for months and up to three years, and the stable phase occurs when the inflammation has stopped.

Who is most at risk of developing TED?

The immune system protects the body from foreign invaders. When a person has an autoimmune disorder, the immune cells mistakenly attack healthy body cells. TED occurs when the immune system attacks the cells surrounding the eyes. It is not entirely clear what exactly causes TED at this time.

TED most often occurs in individuals who have hyperthyroidism or an overactive thyroid. This condition can occur in individuals who have hypothyroidism, but this is not as common. Many individuals who get diagnosed with Graves’ disease also get TED. Graves’ disease is an autoimmune disorder in which the immune system attacks the thyroid gland. Although Graves’ disease doesn’t directly cause TED, they commonly occur together.

It is possible to get TED without any thyroid disorder. However, this is not very common.

Factors that may place you at an increased risk of developing TED include:

• Being a smoker
• Being female

• Having certain genetic factors
• Using radioiodine treatment

Early signs and symptoms of TED

Symptoms of TED will vary as the disease progresses. Early signs of TED differ from the symptoms that will develop later. Although you cannot prevent TED, adjusting certain lifestyle factors can make you less likely to develop this condition.

Early signs of TED include:

• Itchy, dry eyes
• Difficulty wearing contact lenses
• Watery eyes
• Bloodshot eyes

• Swelling of the orbital tissues
• Pain when moving eyes
• Sensitivity to light
• Double vision

As the disease progresses, you may experience the following symptoms:

• Vision impairment
• Difficulty closing the eyes
• Increased light sensitivity

Symptoms of TED can go through phases in which the severity varies and goes into periods of remission. When remission lasts for about six months, it is less likely to return.

How is TED diagnosed?

TED is usually diagnosed with an eye exam. Your doctor will examine both eyes and eyelids to look for signs of the condition. If you have never been diagnosed with a thyroid condition, your doctor will also want to do some bloodwork to examine your thyroid function.

Thyroid hormone levels in the blood can help your doctor determine if your eye problems are related to a thyroid issue. They will look to see if you have any abnormalities in your thyroid hormone levels. Your blood work will likely also test for thyroid stimulating hormone (TSH) levels and thyroid antibody levels. Thyroid antibody tests can help your doctor see if you have a thyroid issue that is autoimmune in origin.

You may also be advised to have some imaging scans done, such as an ultrasound, CT scan, or MRI. Imaging scans give your doctor a look inside your body to see what your thyroid gland looks like. They will look for any abnormalities, such as growths or swelling.

What treatments are available for TED?

If you have been diagnosed with a thyroid condition, then your doctor will take steps to treat that condition first.

• Hyperthyroidism may be treated using antithyroid drugs, radioactive iodine, beta-blockers, or surgery.

• Hypothyroidism is often treated with a thyroid hormone medication called levothyroxine. Levothyroxine helps replace the missing thyroid hormones your body needs to function properly.

Treating thyroid disease does not directly treat thyroid eye disease. Treatment options for TED include the following.

• Over-the-counter medications: Your doctor may recommend over-the-counter eye drops to help with dryness and irritation that happens with TED. Sometimes, doctors will recommend a selenium supplement to help with symptoms.
• Prescription medications:  Anti-inflammatory drugs such as steroids or rituximab are sometimes prescribed to help with symptoms.
• Stop smoking: Smoking can increase your risk of developing TED. Quitting smoking can make a big difference in the effectiveness of treatment, as smoking can make the inflammatory stage last even longer.
• Lifestyle changes: Using a warm compress on your eyes, wearing sunglasses, wearing glasses to help with double vision, and using a patch over one eye can help improve your comfort.
• Surgery: Three main surgical procedures can help with TED: eyelid surgery, eye muscle surgery, and orbital decompression surgery.
  • Eyelid surgery can make it easier for your eyes to close properly, so your cornea remains protected.
  • Eye muscle surgery helps to correct double vision.
  • Orbital decompression surgery helps to relieve pressure to lessen the bulging of the eyes.
• Radiation: Radiation therapy is sometimes recommended as a treatment option for TED.

Symptoms of TED sometimes go away on their own, but it’s important to seek professional help. Your doctor can help guide treatment and determine if there is an underlying issue that needs to be addressed. Treating the underlying thyroid condition is important so that it does not to worsen.

Eye problems can still occur even after treating thyroid conditions. Serious complications are rare with thyroid eye disease, but the condition can lead to vision loss if left untreated.