Thyroid Eye Disease: Symptoms, Stages, Treatment and Warning Signs

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 19, 2026

Quick Answer: What is thyroid eye disease?

Thyroid eye disease (TED), also called Graves' eye disease, is an autoimmune inflammatory condition affecting the tissues around the eyes, most often in people with Graves' disease. Antibodies cause swelling and irritation behind the eyes. Most cases are mild, and treatment depends on severity. Call the care team right away for narrowed vision or sudden severe eye pain. [4]

What the research says

• Smoking strongly raises the risk of Graves’ eye disease. A meta-analysis of 25 studies on smoking and thyroid disorders found an odds ratio of 4.40 (95% CI 2.88–6.73; six studies) for ever-smoking in Graves’ ophthalmopathy, higher than the 1.90 seen for Graves’ disease alone (Vestergaard, Eur J Endocrinol, 2002). [1]

• Selenium helped people with mild disease. In a randomized, placebo-controlled trial of 159 patients with mild Graves’ orbitopathy, selenium (100 µg twice daily for 6 months) improved quality of life (P<0.001), reduced eye involvement (P=0.01) and slowed progression (P=0.01) compared with placebo (Marcocci et al., N Engl J Med, 2011). [2]

• Teprotumumab reduced bulging in active disease, with side effects to weigh. In a randomized trial of 54 Japanese patients with active moderate-to-severe TED, 89% (24/27) on teprotumumab were proptosis responders at week 24 versus 11% (3/27) on placebo (P<0.0001). Study-drug-related adverse events occurred in 52% versus 7%, including hearing impairment in 15% versus 4% (Hiromatsu et al., Lancet Reg Health West Pac, 2025). [3]

How does thyroid eye disease affect the eyes?

TED causes inflammation and swelling in tissues around the eyes. Over time, swelling can make the eyes bulge outward. Inflammation can also affect the eyelids and eye muscles, making it difficult to close or move the eyes normally. In severe cases, the eyes may not close properly, and inflammation can cause lasting changes to appearance or vision.

Symptoms usually affect both eyes, although a person may notice changes in only one eye. TED has distinct phases. During the active phase, symptoms can come and go and may range from mild to severe. The active phase may continue for two years or more before inflammation subsides.

What are the other names for thyroid eye disease?

A care team may use several terms for the same condition, including thyroid ophthalmopathy, thyroid orbitopathy, Graves’ ophthalmopathy, Graves’ orbitopathy and Graves’ eye disease.

What are the symptoms of thyroid eye disease?

Thyroid eye disease usually causes symptoms in both eyes, though some people notice them in only one eye.

Symptom	How it may feel or appear
Bulging eyes, or proptosis	The eyes appear to move forward because tissues around them are swollen.
Eye irritation	The eyes may feel uncomfortable or irritated.
Swollen or inflamed eyelids	The eyelids may become puffy or inflamed.
Dry eyes or teary eyes	The eyes may feel dry or water more than usual.
Frequent blinking	Irritation or dryness may make blinking more frequent.
Light sensitivity	Bright light may feel uncomfortable.
Eye pain or headaches	Inflammation may cause discomfort around the eyes or head.
Difficulty moving the eyes	Swelling or scarring can limit eye movement.
Double vision	Eye-muscle changes can make the eyes misaligned.

Can thyroid eye disease affect only one eye?

Symptoms normally affect both eyes, but sometimes a person notices symptoms in only one eye. A new or worsening eye change should be assessed by a qualified eye-care professional.

What lasting changes can thyroid eye disease cause?

Appearance and vision changes may improve after the active phase, but they do not always disappear. Scarring can prevent tissues around the eyes from returning to their normal shape, and parts of the eyes involved in vision can be permanently damaged.

Possible lasting appearance changes	Possible lasting vision changes
Eyelid retraction	Blurry vision
Protruding eyes	Double vision
Baggy eyes	Severe vision loss
Red eyes	—

Surgery can treat some lasting effects. The best timing depends on disease activity, stability, symptoms and the goals of treatment.

What causes thyroid eye disease?

TED is an autoimmune disease. This means the immune system attacks thyroid and eye tissues. Graves’ disease is a common cause, but Hashimoto’s disease and other autoimmune thyroid conditions can also be associated with TED. People with normal thyroid function can develop it too.

In autoimmune thyroid disease, the immune system creates antibodies that mimic thyroid-stimulating hormone (TSH) and attach to TSH receptors. Most of these receptors are in the thyroid, but some are in the tissues behind the eyes. The same antibodies that affect the thyroid can therefore affect the eyes. [4]

What increases the risk of thyroid eye disease?

Several factors may raise the likelihood of TED or contribute to more severe, longer-lasting symptoms.

Risk factor	What to know
Sex	Females are five times more likely to develop Graves’ disease and Graves’ eye disease. When males develop it, the disease is more likely to be severe.
High or low thyroid hormone levels	Abnormal thyroid hormone levels can contribute to TED.
Radioiodine therapy	Radioiodine is a standard treatment for overactive thyroid, but it may contribute to TED or make it worse.
Smoking	Smoking significantly raises TED risk and can make symptoms more severe and longer lasting.
Secondhand smoke	Smoke exposure from other people can also raise risk and worsen disease.

If you have TED, quitting smoking is described as the best action you can take for the disease. A healthcare professional can help identify appropriate cessation support.

How is thyroid eye disease diagnosed?

A healthcare provider diagnoses TED with a physical eye examination, including an evaluation of both the eyelids and eyes. Blood tests may check thyroid hormone levels and thyroid-related antibodies.

Other tests may include eye ultrasound, CT or MRI. These tests can help evaluate tissues around the eyes and clarify the extent of disease.

Evaluation	What it may assess
Eye examination	Eyelids, eye movement and visible eye changes.
Thyroid hormone blood tests	Whether thyroid hormone levels are high or low.
Antibody blood tests	Whether thyroid-related antibodies are present or abnormal.
Eye ultrasound	Tissues around the eyes.
CT	Detailed images of the eye sockets and surrounding structures.
MRI	Detailed images of the eye sockets and surrounding structures without X-rays.

How is thyroid eye disease treated?

Treatment depends on the stage and severity of disease. Supportive treatments can ease symptoms during the active phase. Some people need a combination of therapies.

Treatment or support	How it may help
Eye drops	Different drops may relieve dryness, redness or pain.
Selenium supplements	Selenium deficiency can increase TED symptoms; supplementation should be discussed with a clinician.
Scleral lenses	These lenses cover more of the eye surface, offer protection and may be used to apply medication.
Eye patch or prism eyeglasses	May help correct double vision while TED is active.
Thionamides	Methimazole or propylthiouracil may reduce thyroid hormone levels when hyperthyroidism is present.
Corticosteroids	A short course by mouth or through a vein may reduce more severe inflammation.
Teprotumumab	A biologic medication specifically approved in the United States for thyroid eye disease. It can cause hearing loss that may be permanent, high blood sugar and flares of inflammatory bowel disease, and it can harm an unborn baby, so birth control is needed during treatment and for 6 months after.
Radiation therapy	May reduce inflammation by targeting active immune cells behind the eyes.

Treatment alternatives may be available if one approach does not work or is not appropriate. Rarely, surgery is needed during the active phase. In most cases, surgery is considered after the condition stabilizes, when it is easier to determine which changes may be permanent.

What surgeries can treat thyroid eye disease?

Surgery may address eye pressure, eyelid exposure, restricted eye movement, misalignment, appearance changes or severe corneal damage.

Surgery	When it may be considered
Orbital decompression	When inflammation compresses the optic nerve or to reduce eye bulging after disease stabilizes. The surgeon removes bone to reduce pressure.
Thyroidectomy	To treat severe hyperthyroidism when thyroid hormone levels cannot be controlled with medication.
Eyelid surgery	To reposition retracted eyelids, improve comfort and appearance, and protect the eyes from exposure.
Eye-muscle surgery	When scarred muscles restrict movement or cause double vision because the eyes are misaligned.
Oculoplastic surgery	To adjust soft tissues or bones around the eyes and address concerns such as bulging or bags.
Corneal transplant	When the cornea has been badly damaged by exposure during active disease and vision may improve with a transplant.

The need for surgery, its timing and its goals depend on disease activity, severity and the structures affected.

What is the outlook for thyroid eye disease?

The outlook is good for most people. Most have mild symptoms that often resolve on their own. People over age 50 tend to have more severe symptoms.

Serious disease may require a combination of treatments. Some people have lasting appearance or vision changes that require surgery. Symptoms and disease activity can change over time, so follow-up is important.

When should you call a healthcare provider?

Call your healthcare provider about thyroid eye disease if symptoms worsen or your vision changes, and call right away for certain warning signs. Call right away if:

Urgent warning sign	Why it matters
Your field of vision has narrowed or closed off	A significant change in the visual field needs urgent assessment.
Colors appear differently than they used to	A change in color perception can signal a serious vision problem.
Sudden, severe eye pain	Sudden severe pain needs prompt evaluation.

Do not wait for a routine appointment when these warning signs occur. Follow local emergency guidance and contact the care team promptly.

What questions should you ask your care team?

Question	Why it helps
Is my thyroid eye disease active?	The phase can influence treatment timing.
How severe is my disease?	Severity helps determine whether supportive care, medication or surgery may be considered.
Which tests do I need?	Eye exams, blood tests and imaging answer different questions.
How will thyroid hormone levels be managed?	Abnormal levels can contribute to TED.
Could radioiodine affect my eye disease?	Your care team can explain treatment choices and risks.
What can help with dryness, pain or double vision?	Supportive measures may make daily activities easier.
Should I use selenium?	A clinician can assess whether supplementation is appropriate.
When would surgery be considered?	Timing is often related to disease stability and the problem being treated.
Which symptoms require an urgent call?	A written plan helps you respond quickly to vision changes.
What support is available for quitting smoking?	Smoke exposure can increase risk and severity.

Conclusion

Thyroid eye disease is an inflammatory autoimmune condition that can affect the tissues, eyelids and muscles around the eyes. Most cases are mild, but symptoms can persist or cause lasting appearance and vision changes. The active phase may last two years or more, so symptoms can change over time.

Diagnosis may include an eye examination, thyroid hormone and antibody tests, ultrasound, CT or MRI. Treatment ranges from eye drops and vision aids to thyroid medicines, corticosteroids, biologic medication, radiation or surgery. Smoking and secondhand smoke can worsen disease, while quitting is an important step.

If you have new or worsening eye symptoms alongside thyroid disease, schedule an evaluation and bring a written list of vision changes, pain, double vision, smoke exposure, thyroid treatments and questions about urgent warning signs.

Frequently Asked Questions

Is thyroid eye disease the same as Graves’ eye disease?

Yes. Graves’ eye disease is another name for thyroid eye disease, especially when the condition occurs with Graves’ disease. Other terms include thyroid ophthalmopathy and thyroid orbitopathy.

Can you have thyroid eye disease with normal thyroid levels?

Yes. Although TED most often occurs with Graves’ disease, it can also occur with Hashimoto’s disease or normal thyroid function.

What is the most common symptom of thyroid eye disease?

Possible symptoms include bulging eyes, eye irritation, swollen eyelids, dry or teary eyes, light sensitivity, eye pain, headaches, difficulty moving the eyes and double vision. A healthcare professional should assess new or worsening symptoms.

How long does the active phase last?

The active phase may last two years or more before inflammation subsides. Symptoms may come and go and may range from mild to severe.

Does thyroid eye disease affect both eyes?

Symptoms normally affect both eyes, but a person may notice symptoms in only one eye.

Does smoking make thyroid eye disease worse?

Smoking and secondhand smoke exposure significantly raise the risk of TED and can make symptoms more severe and longer lasting. Quitting smoking is described as the best action for the disease.

What tests diagnose thyroid eye disease?

Diagnosis may include a physical eye exam, blood tests for thyroid hormone levels and antibodies, and sometimes eye ultrasound, CT or MRI.

What can help with dry eyes during thyroid eye disease?

Eye drops may relieve dryness, redness or pain. Scleral lenses can protect more of the eye surface. A clinician can recommend the most appropriate option.

Is surgery always needed for thyroid eye disease?

No. Most cases are mild and may improve without surgery. Severe or lasting problems may require surgery, usually after the disease stabilizes, although rare active-phase cases require earlier intervention.

When is thyroid eye disease an emergency?

Call right away for a narrowed or closed field of vision, colors appearing differently or sudden severe eye pain. Also tell the care team about worsening symptoms or any vision change.

References

1. Vestergaard P. Smoking and thyroid disorders--a meta-analysis. Eur J Endocrinol. 2002;146(2):153-161. PMID 11834423. https://doi.org/10.1530/eje.0.1460153

2. Marcocci C, Kahaly GJ, Krassas GE, et al. Selenium and the course of mild Graves’ orbitopathy. N Engl J Med. 2011;364(20):1920-1931. PMID 21591944. https://doi.org/10.1056/NEJMoa1012985

3. Hiromatsu Y, Ishikawa E, Kozaki A, et al. A randomised, double-masked, placebo-controlled trial evaluating the efficacy and safety of teprotumumab for active thyroid eye disease in Japanese patients. Lancet Reg Health West Pac. 2025;55:101464. PMID 39896230. https://doi.org/10.1016/j.lanwpc.2025.101464

4. National Institute of Diabetes and Digestive and Kidney Diseases. Graves’ Disease. NIDDK. Last reviewed November 2021. https://www.niddk.nih.gov/health-information/endocrine-diseases/graves-disease

5. National Library of Medicine. Search ClinicalTrials.gov for: Thyroid Eye Disease. ClinicalTrials.gov. Accessed October 31, 2026. https://clinicaltrials.gov/search?cond=Thyroid%20Eye%20Disease

Disclaimer

This article is for general educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition.

It explains what thyroid eye disease is, its symptoms, causes, risk factors, diagnosis, treatment options and outlook. It is not a diagnosis, prognosis or personalized treatment plan. A qualified eye-care or thyroid-care professional should interpret symptoms, blood tests, imaging, disease stage and treatment choices. Call right away for a narrowed or closed field of vision, changed color perception or sudden severe eye pain.