Thyroid eye disease (TED) is an autoimmune disorder that occurs in 25‒50% of patients with Graves’ disease. It is occasionally seen in people with Hashimoto’s thyroiditis or normal thyroid function.1
In TED, the body’s immune system produces antibodies that target the muscles, fat and connective tissues surrounding the eyes, leading to inflammation, redness and swelling. This inflammatory process may also occur in the thyroid gland.2
TED usually affects both eyes. Occasionally, symptoms may only be noticeable in one eye.3
Features of TED include:3,4
<p style="color:#000000">See your doctor immediately if you have worsening eyesight, double vision, or if you notice that colours are not as bright as usual.4</p>
TED is typically diagnosed based on characteristic symptoms, a thorough medical history, physical examination, and a variety of tests, including a thyroid function test.5
The eye doctor will perform a complete eye examination to measure the amount of bulging of your eyes, test your eyesight, and a computerised tomography (CT) scan of the eyes and eye muscles may be required.5
Mild, early TED can be treated conservatively with lubricating eye drops to relieve irritation. If the eyelids do not close properly, taping the eyes shut before sleep can prevent them from drying out.3
A short term (6 months) of selenium supplement may be helpful for slowing the progression of early eye disease.3 Wearing a prism attached to glasses or an eye patch can help correct double vision.5
In moderate to severe TED, high-dose steroids, radiotherapy and/or eye surgery are the main treatments.3 Patients who are at risk for losing their sight may require emergency eye surgery.4
1. Goh SY, Ho SC, Seah LL, et al. Thyroid auto antibody profiles in ophthalmic dominant and thyroid dominant Graves’ disease differ and suggest ophthalmopathy is a multi antigenic disease. Clin Endocrinol (Oxf). 2004; 60: 600-7.
2. Bothun ED, Scheurer RA, Harrison AR, et al. Update on thyroid eye disease and management. Clin Ophthalmol. 2009; 3: 543-51
3. Lim NCS, Sundar G, Amrith S, et al. Thyroid eye disease: a Southeast Asian experience. Br J Ophthalmol. 2014; 0:1-7.
4. Yang M, et al. Management plan and delivery of care in Graves’ ophthalmopathy patients. Best Pract Res Clin Endocrinol Metab. 2012; 26: 303-11.
5. NORD. Thyroid eye disease. Published 2020. Updated 15 March 2022. Available at: https://rarediseases.org/rare-diseases/thyroid-eye-disease/. Accessed 25 May 2023.
