Have you ever wondered about the truth behind those bulging, uncomfortable eyes associated with thyroid disorders? Thyroid Eye Disease (TED) is a complex and often misunderstood condition. In this blog post, we’ll shed light on the various aspects of TED, exploring its autoimmune origins, symptoms, risk factors, diagnosis, treatments, and the latest research.

Key Takeaways

  • Thyroid Eye Disease (TED) is an autoimmune disorder related to Graves’ disease.
  • Early recognition of symptoms and prompt treatment are important for managing TED, which can lead to vision loss if left untreated.
  • Treatments include corticosteroids, lifestyle changes such as quitting smoking and adopting a selenium-rich diet, teprotumumab (Tepezza®), lubricating eye drops, sunglasses & more.

Understanding Thyroid Eye Disease (TED)

Thyroid Eye Disease (TED), also known as Graves’ Eye Disease, is an autoimmune condition that affects the tissues around the eyes, causing inflammation, swelling, and discomfort. Although the precise mechanism responsible for TED is not yet fully understood, it is believed to be related to the immune system’s response to thyroid hormone levels in cases of active thyroid eye disease, which may be associated with thyroid disease.

TED is typically associated with Graves’ disease, a thyroid disorder resulting from an overactive thyroid gland.

Autoimmune Connection

In TED, the immune system mistakenly targets proteins in the cells surrounding the eyes, leading to inflammation and other symptoms such as:

  • double vision
  • eye pain
  • redness and swelling of the eyelids
  • bulging eyes
  • dry eyes
  • difficulty closing the eyes completely

TED shares similar origins as an autoimmune disorder with other conditions like autoimmune disease and rheumatoid arthritis.

The immune system’s attack on healthy tissue, in this case, the thyroid gland and tissues around the eyes, is the primary cause of TED.

Graves’ Disease and TED

Graves’ disease is a frequent cause of TED, with both conditions sharing similar autoimmune origins. In Graves’ disease, the immune system attacks the thyroid gland, leading to an overproduction of thyroid hormones.

This autoimmune attack often targets eye muscles and connective tissue within the eye socket due to the similarity of proteins in these tissues to those of the thyroid gland. Managing thyroid hormone levels may help control the overall symptoms of TED.

Recognizing the Symptoms

The symptoms of TED can range from mild to severe, including eye pain, swelling, protrusion of the eyes, double vision, and decreased vision. The initial indications of TED include redness, irritation, discomfort of the eyes and eyelids, dry eyes, and pain when moving the eyes.

Recognizing these symptoms early and seeking medical attention is vital since untreated TED can result in substantial vision problems.

Mild vs Severe Cases

Mild cases of TED tend to be self-limiting and can be addressed through conservative measures, while severe cases may pose a risk to vision and necessitate more aggressive treatment.

In severe cases, complications such as blindness due to pressure on the optic nerve, corneal ulceration, and orbital congestion may occur, potentially resulting in irreversible vision loss.

Optic Nerve Complications

TED can cause complications involving the optic nerve in some cases, potentially leading to vision loss.

Severe cases of TED may result in complications such as:

  • Blindness due to pressure on the optic nerve
  • Corneal ulceration
  • Marked exposure keratopathy
  • Orbital congestion

Any of these complications may result in irreversible vision loss.

Causes and Risk Factors

TED has the following characteristics:

  • It has a genetic component and is more likely to occur in middle-aged individuals
  • Women are more prone to the condition
  • Cigarette smokers have a higher risk
  • The median age of diagnosis for TED is 43 years
  • The incidence of the disease is 16 per 100,000 individuals assigned female at birth and 2.9 per 100,000 individuals assigned male at birth.

Given that TED can result in vision loss, early diagnosis and treatment are of utmost importance.

Genetic Component

Individuals with TED may possess genetic markers or a genetic susceptibility to the condition, with a familial history of thyroid disorders increasing the likelihood of developing TED.

Several genes with immunologic components have been linked to the development of TED, indicating that genetic factors play a significant role in the emergence of this condition.

Lifestyle and Environmental Factors

Lifestyle and environmental factors, such as smoking and stress, have been identified as potential contributors to Thyroid Eye Disease (TED). Smoking may increase the likelihood of developing TED, as well as exacerbate the symptoms associated with the disease.

Stress can not only increase the risk of developing TED but can also worsen the condition’s symptoms.

Diagnosing TED

Diagnosis of TED involves patient history, clinical evaluation, imaging techniques like CT scans, and thyroid function tests.

Any eye involvement during the active phase of the disease should be continually evaluated by an ophthalmologist, who will provide treatment as required.

Imaging Techniques

Imaging techniques, such as CT scans, can help visualize the affected eye structures and assess the severity of TED.

A CT scan may be utilized to evaluate whether the optic nerve is compressed by enlarged, inflamed muscles in the eye in moderate to severe cases of TED.

Thyroid Function Tests

Thyroid function tests can help determine if an underlying thyroid disorder is contributing to TED.

To diagnose Thyroid Eye Disease (TED), Thyroid stimulating hormone (TSH), T4, T3, and thyroid antibody tests are employed.

Treatment Options for TED

Treatment for TED may include medical therapies like corticosteroids, teprotumumab, and radiation therapy, as well as surgical interventions in severe cases.

The primary focus of treatment during the active phase of mild thyroid eye disease is to protect sight and the cornea and provide treatment for double vision if it affects daily activities and becomes a nuisance. To effectively treat thyroid eye disease, addressing these concerns during the active phase is crucial.

Medical Therapies

Medical therapies aim to reduce inflammation and manage symptoms while also addressing any underlying thyroid disorders. Corticosteroids, such as prednisone, may be used to treat the acute swelling leading to double vision or loss of vision in thyroid eye disease for a limited period.

The first FDA-approved medication for treating thyroid eye disease is teprotumumab trbw (Tepezza®).

Surgical Interventions

Surgical interventions, such as eye muscle surgery, may be necessary in severe cases to correct double vision problems or improve the appearance of the eyes.

Surgical treatments for Thyroid Eye Disease (TED) include orbital decompression, eyelid surgery, and strabismus surgery.

Orbital Decompression

Orbital Decompression is a surgical procedure often used in severe Thyroid Eye Disease (TED) cases. When TED causes significant inflammation and swelling, the eye muscles and fat can expand within the bony eye socket, causing the eyes to protrude or ‘bulge’ outwards. This condition, known as exophthalmos, can lead to discomfort, difficulty closing the eyes, and even vision loss.

Orbital decompression surgery aims to alleviate these symptoms by creating more space within the eye socket for the swollen tissues. The procedure involves removing a part of the bone from the eye socket, thereby reducing the pressure on the eye and allowing it to move back into a more normal position. This can help reduce eye protrusion and improve related symptoms.

The surgery is performed under general anesthesia and can be done through various approaches, including transconjunctival (through the inside of the eyelid), transcutaneous (through the skin), or endoscopic (using a small camera and instruments). The choice of approach depends on the severity of the disease, the specific areas of the eye socket that need to be decompressed, and the surgeon’s expertise.

Orbital decompression is not without risks and potential complications, including double vision, changes in eyelid position, and, in rare cases, vision loss. Therefore, the decision to undergo this procedure should be made in consultation with a skilled ophthalmologist or orbital surgeon specializing in treating TED.

Post-surgery, patients may experience temporary swelling and bruising, which typically improves over a few weeks. Full recovery and stabilization of the eye position may take several months. Patients must follow their doctor’s instructions regarding eye care, medication, and follow-up appointments to ensure the best possible outcome during this period.

Coping with TED

Coping with TED involves eye care tips, such as using lubricating eye drops and wearing sunglasses, as well as making lifestyle changes like quitting smoking.

Proper eye care can help alleviate symptoms and prevent complications associated with TED.

Eye Care Tips

The use of the following can provide relief from symptoms and prevent complications for patients with Thyroid Eye Disease:

  • Lubricating eye drops
  • Sunglasses
  • Artificial tears throughout the day
  • Gels or ointments at night

Additionally, some patients may benefit from the use of eye covers at night or taping their eyes shut if the eyelids do not close properly.

Lifestyle Changes

Adopting a healthy lifestyle, including quitting smoking, can help reduce the risk of developing or worsening TED.

Quitting smoking and adopting a selenium-rich diet may aid in reducing the risk of developing or worsening TED, due to their potential to decrease inflammation and strengthen the immune system.

Selenium-Rich Diet and TED

A diet rich in selenium can be beneficial for individuals with Thyroid Eye Disease (TED). Selenium is a trace mineral that is crucial to the body’s metabolism and thyroid function. It is also known to have antioxidant properties that can help reduce inflammation, a key factor in TED.

Including selenium-rich foods in your diet can help maintain optimal thyroid function and potentially alleviate symptoms of TED. Foods that are high in selenium include:

Food GroupSpecific FoodsSelenium Content
SeafoodTuna, Halibut, Sardines, Shrimp, Oysters, Clams, ShellfishHigh
Meat and PoultryChicken, Turkey, Beef, LambGood
Nuts and SeedsBrazil Nuts, Sunflower Seeds, WalnutsHigh (especially Brazil Nuts)
Whole GrainsBrown Rice, Oatmeal, Whole Wheat BreadGood
DairyMilk, Yogurt, CheeseGood
VegetablesMushrooms, Spinach, AsparagusGood
It is important to note that while selenium can be beneficial, excessive intake can lead to selenium toxicity. Therefore, it’s crucial to maintain a balanced diet and not exceed the recommended daily intake of selenium, which is 55 micrograms for adults.

TED and Smoking

Smoking has been identified as a significant risk factor for developing and progressing Thyroid Eye Disease (TED). Cigarette smoke contains numerous harmful substances that can lead to inflammation and oxidative stress, exacerbating TED symptoms.

Studies have shown that smokers with Graves’ disease are more likely to develop TED than non-smokers, and their disease tends to be more severe. Smoking can also interfere with treatments for TED, making it less effective.

Quitting smoking is strongly recommended for those with TED or at risk of developing the disease. Cessation of smoking not only reduces the risk of developing TED but can also improve the response to treatments and slow the progression of the disease.

Emerging Research and Clinical Trials

Emerging research and clinical trials are exploring breakthrough treatments like teprotumumab and investigating new approaches to managing TED.

Teprotumumab, designated as a “breakthrough therapy” by the FDA, has shown a significant reduction in symptom intensity in clinical trials.

Teprotumumab: A Breakthrough Treatment for TED

Teprotumumab, often marketed under the brand name Tepezza®, is a monumental breakthrough in the treatment of Thyroid Eye Disease (TED). It is the first FDA-approved medication specifically designed to treat TED, offering new hope to patients who have long struggled with the discomfort and vision impairments associated with this condition.

Teprotumumab is a fully human monoclonal antibody, which works by inhibiting the insulin-like growth factor-1 receptor (IGF-1R). This receptor is thought to play a crucial role in the pathogenesis of TED, and by blocking its activity, teprotumumab can help reduce inflammation and swelling in the eye tissues, thus alleviating the symptoms of TED.

Clinical trials have shown teprotumumab to be highly effective in reducing the severity of TED symptoms. In a study conducted by the University of Michigan Kellogg Eye Center, patients who were administered teprotumumab showed a significant reduction in eye bulging, double vision, and inflammation. This marked improvement in symptoms greatly enhanced the patients’ quality of life, underscoring the potential of teprotumumab as a game-changing treatment for TED.

Despite its effectiveness, teprotumumab is not without its side effects. Some patients may experience reactions to the infusion, including nausea, muscle spasms, diarrhea, and fatigue. However, these side effects are usually manageable and do not outweigh the significant benefits of this treatment.

Teprotumumab represents a significant step forward in treating TED, providing patients with a new, effective treatment option. As research continues, the potential for further advancements in TED treatment is promising.

Future Directions

Future research aims to deepen our understanding of the underlying causes of TED and devise more efficacious treatment options.

Potential directions of research and clinical trials for Thyroid Eye Disease (TED) include:

  • Studying linsitinib
  • Studying teprotumumab
  • Evaluating novel treatments
  • Assessing targeted therapy options

In conclusion, understanding Thyroid Eye Disease (TED) is crucial for effective management and treatment. Individuals affected by TED can seek appropriate medical care and make lifestyle changes to improve their condition by recognizing its autoimmune origins, identifying symptoms, and addressing risk factors. With ongoing research and breakthrough treatments like teprotumumab, there is hope for a brighter future for those living with TED.

Frequently Asked Questions

What triggers thyroid eye disease?

TED is primarily associated with Graves’ Disease and can occur before, during or after the diagnosis of a thyroid disorder. About a quarter of patients with Graves’ Disease develop TED, making it the most common trigger for this disease.

Can you fix thyroid eye disease?

Thyroid eye disease is often treatable, with mild cases sometimes resolving on their own and more serious cases requiring a combination of therapies. Treatment can help improve symptoms, though in some cases permanent changes may remain and surgery may be necessary. In mild cases, the disease may resolve on its own without any treatment. However, more serious cases may require a combination of therapies, such as medications, radiation, and/or surgery. Treatment can help improve symptoms, though

What does thyroid eye disease feel like?

Thyroid eye disease can cause symptoms such as itching, dryness or grittiness of the eyes, watering and swelling around the eyelids.

How does thyroid problems affect the eyes?

Thyroid problems can cause thyroid eye disease, an autoimmune disorder leading to eye soreness, protruding eyeballs, vision changes, dry and gritty eyes, sensitivity to light, and double vision. In severe cases, vision loss may also occur.

Is Graves disease very serious?

Graves’ disease can be serious, as when left untreated or not well-controlled, it can cause potential complications such as arrhythmia, heart failure, or stroke.


  1. Thyroid Eye Disease” from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Link
  2. What is Thyroid Eye Disease? from the American Academy of Ophthalmology Link
  3. “Thyroid Eye Disease” from the Mayo Clinic Link
  4. “Thyroid Eye Disease (Graves’ Ophthalmopathy)” from the American Thyroid Association Link
  5. “Understanding Graves’ Eye Disease” from the National Eye Institute Link
  6. “7 Reasons to Quit Smoking with Thyroid Eye Disease – Healthline”[Link](https://www.healthline.com/health/smoking-thyroid-eye-disease)
  7. “Cigarette smoking and thyroid eye disease: a systematic review – PubMed”[Link](https://pubmed.ncbi.nlm.nih.gov/16980921/)
  8. “Effects of Smoking on Outcomes of Thyroid Eye Disease Treated with Teprotumumab: A Retrospective Cohort Study – PMC – NCBI”[Link](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10035644/)


Photo graph of Dr. Conlon operating with loops on.

Dr. M. Ronan Conlon started his career in the field of ophthalmology at the same time as the development of refractive eye surgery in Canada. In 1996, he brought laser technology to Canada from Germany, which allowed him to perform laser eye surgery before it was available in the United States. With the establishment of the Conlon Eye Institute, Dr. Conlon has performed more than 40,000 refractive procedures and has advanced his expertise in LASIK and refractive cataract surgery.

The information on this page should not be used in place of information provided by a doctor or specialist.


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