Thyroid Eye Disease (TED) Causes, Symptoms, and Treatments

Your thyroid gland is an organ at the front of your throat. It makes hormones that affect almost every part of your body, including your eyes.

Thyroid eye disease (TED) is a health issue that results in sensitive, bulging eyes. It's triggered by an autoimmune disorder called Graves' disease.

Symptoms of TED sometimes go away on their own.

Doctors can treat severe cases of TED with medicine or surgery.

On this page:

• TED causes.
• TED symptoms.
• TED diagnosis.
• TED treatment.

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What Is Thyroid Eye Disease (TED)?

TED (also called Graves' eye disease) is a health issue where swelling around the eyes makes them bulge.

It's caused by Graves' disease, a disorder where your immune system attacks your thyroid gland. Your thyroid gland then makes too much thyroid hormone.

Your thyroid gland is in your throat and shaped like a butterfly. It makes hormones that control your metabolism. These hormones affect almost every part of your body, including your eyes.

How common is TED?

TED is rare. It occurs in about 19 out of 100,000 people in the U.S. But it's five times more common in women than it is in men.

You can get thyroid eye disease at any age, but it's most common in middle age.

TED isn't contagious. You can't catch it from someone else.

What causes thyroid eye disease?

Graves' disease is most often the cause of TED.

About one in three people with Graves' disease get symptoms of thyroid eye disease.

What's Graves' disease?

If you have Graves' disease, your immune system attacks the thyroid gland. The thyroid then makes more hormones than the body needs, and these hormones speed up functions in your body.

Doctors aren't sure the exact cause of Graves' disease.

People with certain gene mutations may be more likely to get it. Viruses may trigger the disease to form in people with these genes.

Graves' disease symptoms include:

• An increased heart rate.
• Weight loss.
• Nervousness.
• Trouble tolerating heat.

It can cause serious health problems, including eye disease.

In rare cases, an underactive thyroid causes TED.

What are thyroid eye disease risk factors and complications?

TED risk factors

Graves' disease is the main risk factor for getting TED.

Other risks include:

• Being born female. Women are more likely than men to get TED.
• Having a family history of Graves' disease or Hashimoto's disease.
• Having another autoimmune disease. Having type 1 diabetes or rheumatoid arthritis puts you at greater risk for thyroid eye disease.
• Smoking, which increases the risk for eye problems in people with Graves' disease.

Complications of TED

Having “thyroid eyes" or “Graves' disease eyes" can reduce your quality of life. You may feel self-conscious and avoid other people because your appearance has changed. This can lead to anxiety and depression.

In rare cases, the swelling around the eyes presses on the optic nerve, which connects the eye to your brain. The swelling can lead to vision loss.

How can I prevent thyroid eye disease?

There's no known way to prevent TED. If you smoke, cutting back will reduce your risk of double vision and bulging eyes.

Thyroid Eye Disease Symptoms and Diagnosis

What are the signs and symptoms of TED?

Thyroid eye disease symptoms often appear within the first year after you're diagnosed with Graves' disease.

Symptoms tend to affect both eyes. But you may only notice symptoms in one eye.

Symptoms of thyroid eye disease include:

• A dry or gritty feeling (like sand) in your eyes.
• Blurry vision.
• Bulging eyes that seem to stare.
• Double vision.
• Eye pain or pressure.
• Red, swollen eyes.
• Sensitivity to light.
• Swollen eyelids.
• Trouble closing your eyes all the way.
• Watery, teary eyes.

How do you diagnose thyroid eye disease?

An ophthalmologist will give you a complete eye exam. It's more in-depth than a routine vision exam.

During the exam, they'll look closely at your eyes and eyelids for signs of TED.

Other tests may include:

• Blood tests to check thyroid hormone levels.
• CT scan.
• MRI.
• Ultrasound.

What Are the Treatment Options for Thyroid Eye Disease?

At the UPMC Multidisciplinary Thyroid Eye Disease Clinic, you'll see an ophthalmologist and an endocrinologist. These experts will work together to assess and treat your thyroid eye disease.

We may also call in surgeons and ear, nose, and throat (ENT) doctors when needed.

Treatment for an overactive thyroid may help with TED. Your doctor may suggest other treatments.

At-home TED treatments

You can do some treatments at home.

These include:

• Lubricating gel. Use this gel before bedtime if your eyelids don't close all the way. The gel will help your eyes from drying out while you sleep.
• Over-the-counter eye drops. “Artificial tears" can help soothe dry, irritated eyes. Choose eye drops that are for lubrication.
• Prism lenses. If you have double vision, these special prescription lenses can help you see more clearly.
• Quitting smoking. Smoking can make thyroid eye disease worse. Quitting is likely the most vital lifestyle change you can make.
• Raising your bed. Raising the head of your bed can relieve eye pressure and reduce swelling.
• Sunglasses. Wrap-around sunglasses protect your eyes the best and also keep wind away from your dry eyes.

Medical thyroid eye disease treatment

Your doctor may also advise treatments such as:

• Medicines. Your doctor may suggest a steroid (like prednisone®) or other medicines to reduce swelling behind the eyes. Teprotumumab is a new medicine that may help with TED.
• Radiation. Low-dose radiation can help reduce swelling in the tissues around the eyes.
• Surgery. If TED affects your vision, your doctor may suggest orbital decompression eye surgery. It makes the eye socket bigger, eases pressure on the optic nerve, and helps the eye move back into place. Eyelid surgery can also help your eye go back to its normal position.

Thyroid eye disease prognosis

Most cases of TED are mild. Symptoms usually last a year or two and often go away on their own.

Many people recover after getting treatment for their overactive thyroid.

If you're over 50 when you get diagnosed with thyroid eye disease, you may have a worse prognosis.