Understanding Thyroid Eye Disease (TED) / Graves' Eye Disease

March 24, 2025

Norman Nickel

A condition with many names, Thyroid Eye Disease (TED), also known as Graves' Ophthalmopathy or Graves’ Eye Disease is where the immune system erroneously attacks the muscle and fat tissue around your eyes causing swelling and discomfort. TED is more likely to happen with individuals with Graves’ Disease, hence “Graves’ Eye Disease”. Ordering the Thyroid-Stimulating Antibodies Blood Test and Thyrotropin Receptor Antibody Test would determine if you could have Grave’s Disease as these are the two types of antibodies linked to the disease. But testing for your TSH, T4, T3, TSI, TrAb, or Anti-TPO can assist your physician in determining if you have Thyroid Eye Disease. Click here to see all of our thyroid-related tests.

What is Thyroid Eye Disease?

Thyroid Eye Disease (or TED) is an autoimmune disease that affects some individuals with autoimmune thyroid disease. TED is mostly common in individuals with hyperthyroidism (an overactive thyroid) due to Graves’ disease. Roughly a third of people with Graves’ disease develop TED. Fortunately, TED is a mild symptom of Graves’ disease. TED may be active for two years or more before inflammation subsides, though in some cases, medications and surgery may be necessary.

What Are the First Signs of Thyroid Eye Disease?

One of the more common first signs of thyroid eye disease is eyelid retraction. Eyelid retraction happens when the upper or lower eyelid is pulled back from its normal position. Some other symptoms include persistent red eyes, puffiness, and/or swelling around the eyes. Some develop discomfort from behind their eyes as well. Proptosis (bulging eyes), where the eyeball protrudes abnormally from its socket, is a typical finding as well. Your vision can be affected as well. Many individuals can experience double vision. In severe cases, an individual may have vision loss due to eyelid retraction.

Women are more likely to develop Thyroid eye disease than men. Women are 5x more likely to develop thyroid eye disease, though men experience harsher symptoms. Smoking (and secondhand exposure to nicotine products) and radioiodine therapy (RAI Therapy) may contribute to TED or even make symptoms worse. The most common symptoms include:

bulging eyes
dry eye
swelling around the eyes
eye pain and headaches
redness and irritation
double vision
difficulty closing the eyes
sensitivity to light

Can Thyroid Eye Disease Be Cured?

While there is no cure for thyroid eye disease, individuals can effectively manage their symptoms and slow down the progression of the disease. Treatment can range from eye drops and steroids to, in severe cases, surgery. By treating thyroid eye disease early and having a solid plan for managing symptoms, individuals can improve their own quality of life.

How Long Can You Live With Thyroid Eye Disease?

Remember, there are two phases of TED: the active phase and the stable phase. During the Active phase, which can last anywhere from 6 months to two years, individuals may want to seek medical treatment to relieve eye symptoms. During the Stable Phase, which occurs whenever inflammation and other symptoms subdue, individuals may want to consider surgery to correct the more visible effects of Thyroid Eye Disease.

Thyroid Eye Disease is a Symptom of Graves’ Disease. Is Graves’ Disease, Hereditary?

Graves' disease is a condition that affects the function of the thyroid leading to an overactive thyroid, also known as hyperthyroidism. Graves’ Disease affects about 1 in every 200 people and is the most common cause of overactive thyroid. Researchers have determined that there are genetic and environmental factors that come into play, however, autoimmune diseases are still being studied by researchers.

Researchers say “something” triggers your immune system to overproduce an antibody called thyroid-stimulating immunoglobulin (TSI). TSI attaches to healthy thyroid cells, causing your thyroid to overproduce thyroid hormones. Researchers believe the trigger of the attack may be a combination of genetic predisposition and environmental factors, like stress, pregnancy, or an infection/virus.

How Is Graves’ Disease Diagnosed? How is Thyroid Eye Disease Diagnosed?

Your physician can inquire about your symptoms and medical family history and do a physical exam to diagnose. They may also confirm Graves’ Disease with a Thyroid Blood Test, Thyroid Antibody Blood Test, and other medical procedures.

Testing for your TSH, T4, T3, TSI, TrAb, or Anti-TPO can assist your physician in determining if you have Thyroid Eye Disease.

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