Thyroid eye disease (TED)

Overview  |  Symptoms  |  Causes  |  Risk Factors  |  Diagnosis  |  Treatment  |  FAQs 

Thyroid eye disease causes bulging eyes and, in severe cases, can lead to vision loss. Identifying the condition early can help us protect your eye health and prevent it from worsening. Contact our clinic for specialist diagnostic tests and treatment.

What is thyroid eye disease?

Thyroid eye disease (TED) is also known as Graves’ ophthalmopathy or Graves’ eye disease (GED). It is an autoimmune condition that occurs due to hyperthyroidism (an overactive thyroid), usually due to Graves’ disease. TED causes inflammation (swelling) and damage to muscles, fatty tissue and connective tissue in and around the eyes.

The two phases of TED are active and inactive. In the active or inflammatory phase, your symptoms, such as swelling, are ongoing. It may last around six months to two years. We also call this the acute stage. In the inactive or stable phase, the swelling and other symptoms stop or lessen significantly. Another name for this is the chronic stage.

Symptoms

During the active phase of TED, your eyes may bulge (proptosis), making you look surprised or like you are staring. Some people call this the thyroid stare. Your eyes or eyelids may also look red or puffy. 

Additional symptoms can include: 

Swelling and inflammation can increase pressure within the orbit (eye socket), indirectly affecting the optic nerve and surrounding structures. The optic nerve, which connects the retina in each eye to your brain, becomes compressed and, in rare and severe cases, untreated TED can lead to vision loss. Optic nerve damage can also lead to secondary glaucoma.

 

First signs of TED

In the early stages, it’s common to experience itchy, watery, and dry eyes. If you are developing a thyroid problem, you may feel tired or lack energy and have a sudden weight change, either a loss or a gain.

Other early warning signs include dizziness and sleep problems, such as insomnia or feeling very sleepy. You may feel depressed and experience mood swings, irritability, or anxiety. 

Women and people assigned female at birth (AFAB) may notice changes to their menstrual cycles, such as lighter periods, heavier periods, and an irregular cycle. 

Causes

In most cases, an overactive thyroid causes TED, though it can occur in those with an underactive thyroid or one that functions as it should. You may have an overactive thyroid if you have Graves’ disease, thyroid nodules (lumps on your thyroid), high levels of iodine, or Hashimoto’s thyroiditis.

As TED is an autoimmune condition, it causes the immune system to attack healthy tissue cells around the eyes.

Graves’ disease and TED

Having Graves’ does not mean that you will develop TED. About one in four people with Graves’ develop TED. You should attend regular eye checks to monitor your eye health if you are diagnosed with Graves’ disease.

Risk factors

Anyone can develop this condition, though it is more common in people with Graves’ or thyroid problems. Women are more likely to develop TED than men, and the average age for a diagnosis is 43. 

Other factors can increase your risk, including having a family member with the condition and smoking, especially heavy smoking. E-cigarettes may increase your risk as they also contain nicotine. Smoking can extend the active phase and prevent TED treatments from working effectively. We recommend cutting down or quitting if possible to avoid worsening your condition. 

Diagnosis

If your doctor suspects a thyroid problem, they will order blood tests, such as a thyroid function test to measure your thyroid hormone and thyroid-stimulating hormone (TSH) levels. They may also check for anti-thyroid antibodies if they suspect an autoimmune thyroid disease. After these tests, your doctor may refer you to an ophthalmologist (eye specialist) for further investigation.

Our eye specialist will review your medical history and examine your eyes and eyelids to look for signs of TED. We can also use CT and MRI scans to look for swelling in the tissue behind the eyes. If we determine you are in the active phase, we can suggest a suitable treatment.

Treatment

How we treat your condition depends on its severity and whether you are in the active or stable phase. An eye specialist works with an endocrinologist to treat TED and the underlying cause. Together, they may recommend medications to treat your thyroid problem. These can include hormone replacement therapy for hypothyroidism and radioactive iodine therapy or beta-blockers for hyperthyroidism. Some people require surgery to remove their thyroid gland.

If your condition is mild, we may recommend lubricating eye drops to help with dry eyes. Pressing a cold compress on your eyes may reduce swelling caused by TED, and you may also benefit from wearing sunglasses and taking selenium supplements. We may recommend steroids, immunosuppressive agents, and orbital decompression surgery for a more severe condition.

When your condition is stable, you may still have a starry-eyed look, which some find cosmetically unappealing. Our specialist, Mr Daniele Lorenzano, can provide blepharoplasty (eyelid surgery) to address this if your condition is still mild or orbital decompression if severe.

Preventing TED from progressing

While you cannot prevent TED itself, you may be able to slow its development. Quitting smoking can slow the progression of this condition, as can managing your thyroid dysfunction. If you are in the active phase, you should avoid radioiodine therapy.

Book an appointment

Are you experiencing changes in your eyes that concern you, such as swelling or discomfort? Thyroid eye disease might be the reason. Don’t ignore symptoms like bulging eyes, redness, or dryness. Our expert team at Oculase is here to help.

Book an appointment now to have your eyes evaluated by our skilled ophthalmologist. Early detection and tailored treatment can make a significant difference in managing TED and preserving your eye health. 

FAQs

    No, you cannot prevent thyroid eye disease, but you can prevent it from progressing, as we discuss above.

    No, TED is not common. In fact, it is a rare autoimmune condition that affects about 19 in 100,000 people per year. Around 16 of these are women, and 3 are men.

    It is possible to experience a recurrence of TED after thyroidectomy, but it is rare. Thyroidectomy treats hyperthyroidism due to Graves’ disease, a common underlying cause of TED. However, you may still experience side effects of TED symptoms.

    Yes, you can have thyroid eye disease without Graves’ disease. Roughly one in ten people with TED do not have Graves’. You may also receive a Graves’ diagnosis after a TED diagnosis.

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