Thyroid Eye Disease (TED) (Graves' Ophthalmopathy) is relatively common in people with autoimmune thyroid conditions, affecting about 1 in 4 (25-40%) of those with Graves' disease, but most cases are mild, with only 5-6% developing moderate to severe symptoms. While women are more often affected, men tend to experience more severe outcomes, and smoking significantly increases the risk and severity, by up to eightfold.
What causes Thyroid Eye Disease? Thyroid Eye Disease is an autoimmune condition, which means that the body's immune system mistakenly targets its own tissues. The immune system's attack on the muscles that move the eye causes them to thicken and become stiff.
Although TED can never truly be cured and doesn't fully “go away” in the traditional sense, it can go into remission. For many, the active phase resolves, leaving behind a quieter, more stable condition. Some people experience mild symptoms that linger, while others find their condition stabilizes entirely.
Although autoimmune diseases are lifelong, TED has distinct phases. It may be active for two years or more before the inflammation subsides. During this time, symptoms may come and go and may be mild to severe. TED is mild for most people.
Graves' eye disease usually affects both eyes, but you may only notice symptoms in 1 eye. Symptoms usually last 1 to 2 years and often go away on their own. In rare cases, swelling around the eyes can press on the optic nerve (the nerve that connects the eye to the brain) and cause vision loss.
Thyroid conditions are also more common in women. External examination: Observing the eyes allows the doctor to check for bulging, redness, or swelling. Internal examination: The eye doctor can measure eye pressure to evaluate glaucoma risk, which is associated with thyroid eye disease.
In Graves' eye disease the tissue around the eye is attacked, and the result is inflammation and swelling, causing:
The Role of Stress in Graves' Disease and TED
Some people with Graves' also develop TED, a condition where the immune system attacks tissues around the eyes. TED can lead to eye bulging, pain, dryness, and even vision problems. Stress is a major factor in both conditions.
TED is more common in women than men, though men are more likely to have more severe eye disease. The condition can affect people of any age, though it typically occurs in those between ages 30 and 50, and it is less common in children.
For some, removing the thyroid and stabilizing hormone levels can lead to an improvement in Thyroid Eye Disease (TED) symptoms. But for others, the damage done during the active phase of the disease—like bulging eyes or double vision—may stick around even after the thyroid is removed.
About one in every three people with Graves' disease develop eye symptoms. While eye symptoms can occur at any time, they usually appear within the first year of diagnosis of Graves' disease. TED is usually mild and gets better on its own over time. Some cases can be quite severe and can require medications or surgery.
Surgery. When thyroid eye disease is stable and not in the inflammatory stage, we may perform surgery to improve TED symptoms or cosmetic concerns. Depending on your needs, surgical options include: Orbital decompression: We may remove excess fat or bone to reposition the eye in the socket and treat eye bulging.
Most patients think once their medical doctor treats the body's thyroid problem the eyes will go back to normal. This is often not the case. In some patients the eyes worsen in the months and years after medical treatment despite the body being stabilized.
Thyroid Eye Disease (TED) can be confused with a separate condition called Graves' disease. There are a few reasons for this. One reason is that TED and Graves' disease are both autoimmune conditions. Normally, the immune system can tell the difference between your cells and foreign cells, like bacteria.
Prescription drugs or surgery to treat TED
Symptoms of thyroid eye disease include bulging eyes and seeing double. An eye doctor can prescribe prism glasses to readjust how light enters your eyes, helping you see better.
How does Thyroid Eye Disease progress? There are two phases of Thyroid Eye Disease (TED) or Graves Eye Disease. The active phase, marked by inflammation, usually lasts from six months to two years. The focus during this stage is on medical treatment to relieve the eye symptoms.
Early signs of thyroid problems often involve energy, temperature, and body changes, such as unexplained weight changes, fatigue, mood shifts (anxiety/depression), skin/hair issues (dryness, thinning), and altered heart rate or bowel habits, with hypothyroidism causing slow-down (cold, constipation, weight gain) and hyperthyroidism causing speeding up (heat, anxiety, weight loss, fast heart rate).
Daily habits such as irregular sleep, skipped meals, and stress can harm thyroid function. Improving your routine can offer significant relief and support hormonal recovery.
Thyroid hormones are essential for brain function. Low or high levels can lead to issues like anxiety, depression, difficulty concentrating and mood swings. Many people don't realize that what feels like a mental health issue could be thyroid related.
Currently, there's no cure for hypothyroidism. But you can successfully manage the condition with hormone replacement therapy.
An overactive thyroid can affect anyone, but it's about 10 times more common in women than men, and typically happens between 20 and 40 years of age.
In thyroid eye disease the tissue around the eye is attacked by inflammatory cells and the result is inflammation, swelling, and bulging of the eye. Thyroid disease and thyroid eye disease both come from the immune system attacking healthy tissue. We now know one disease does not directly cause the other.
There is currently no cure for TED, but you will receive specialized therapies once you are diagnosed with TED. Can thyroid eye disease go back to normal? With the appropriate treatment plan, your eyes can return to normal.
Thyroid eye disease can cause eye pain, double vision, loss of vision, and changes to your appearance which may impact your quality of life. The impacts of TED may lead you to experience to depression, anxiety, loss of independence, and reduced self-confidence.