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PubMed This is a summary of 104 peer-reviewed journal articles Updated
Endocrinology · Thyroid Eye Disease

Understanding Thyroid Eye Disease: An Empowering Guide

At a Glance

Thyroid Eye Disease (TED) is an autoimmune condition that causes inflammation and swelling in the tissues around the eyes. It progresses through an active inflammatory phase and an inactive stable phase. Quitting smoking and stabilizing thyroid levels are critical steps to prevent worsening symptoms.

Finding out that your thyroid condition is affecting your eyes can be a frightening and disorienting experience. You may notice your eyes looking different in the mirror or feeling uncomfortable in ways that are hard to describe. It is important to know that Thyroid Eye Disease (TED) is a well-understood medical condition with clear phases and effective modern treatments [1]. While the changes to your face and vision can be upsetting, you are not alone, and there is a dedicated timeline where medical intervention can make a significant difference.

What is Thyroid Eye Disease?

Thyroid Eye Disease (TED) is an autoimmune condition, meaning your body’s immune system mistakenly attacks the healthy tissues behind and around your eyes [2]. In TED, the immune system targets the fat and muscles in the eye socket (the orbit), causing inflammation, swelling, and sometimes a “bulging” appearance known as proptosis [3][4]. You can learn more about how this happens in The Biology and Risk Factors Behind TED.

The Thyroid Connection

TED is most commonly linked to Graves’ disease, an autoimmune condition that causes an overactive thyroid (hyperthyroidism) [2]. However, the relationship is not always straightforward:

  • Most patients (about 90%) have hyperthyroidism [3].
  • Some patients may have an underactive thyroid (hypothyroidism), such as those with Hashimoto’s disease [3].
  • Euthyroid patients have normal thyroid hormone levels but still develop eye symptoms because the autoimmune attack on the eyes can happen independently of the thyroid gland itself [2][5].

The Two Phases of TED: Understanding Your Timeline

TED follows a predictable path often called Rundle’s Curve. Understanding where you are on this curve is vital because it determines which treatments will work best for you [6]. To see how doctors measure your progress, visit Staging and Scoring Your Progress: CAS and EUGOGO.

01

Stopping the Fire: Treatments for the Active Phase

Learn about active phase Thyroid Eye Disease (TED) treatments. Compare IV steroids and Teprotumumab (Tepezza) for reducing eye bulging and double vision.

02

Restoring Your Appearance: Surgical Rehabilitation

Learn about the 3-step surgical rehabilitation process for Thyroid Eye Disease (TED). Understand orbital decompression, muscle surgery, and eyelid surgery.

Facing the Emotional Impact

It is completely normal to feel a sense of shock, grief, or “facial identity loss” as your appearance changes [13]. TED can change the way you look at yourself and how you interact with others, often leading to social withdrawal or anxiety [14]. Advocating for your mental health is a vital part of your care journey, which we cover in The Long-Term Journey: Quality of Life and Care.

Immediate Steps You Can Take

While you work with your care team on a long-term plan, there are several things you can do right now to protect your eyes:

  • Stop Smoking: Smoking is the single greatest risk factor for worsening TED. Quitting significantly improves the chances of treatment success [15].
  • Stabilize Your Thyroid: Work closely with your endocrinologist to keep your thyroid levels in a healthy range, as “swings” in hormone levels can flare the eye disease [15].
  • Manage Discomfort: Use preservative-free artificial tears during the day and lubricating gels at night to protect the surface of your eyes from drying out [15].
  • Selenium Supplements: For mild cases, your doctor may recommend selenium, which has been shown to improve eye symptoms [16]. However, this is strictly a temporary intervention (typically a 6-month course); taking excess selenium long-term can cause toxicity, so you must do this under a doctor’s guidance [16].

For more on daily management and warning signs, read Recognizing Symptoms and Red Flags of TED.

Common questions in this guide

What are the different phases of Thyroid Eye Disease?
TED follows a timeline with two main stages, often called Rundle's Curve. The active phase involves ongoing inflammation and swelling that lasts one to three years, while the inactive phase is when inflammation settles but structural changes may remain.
Do I have to have an overactive thyroid to get Thyroid Eye Disease?
No, while about 90% of people with TED have an overactive thyroid from Graves' disease, it is not required. You can develop eye symptoms even if your thyroid is underactive or functioning completely normally.
Can smoking make my Thyroid Eye Disease worse?
Yes, smoking is the single greatest risk factor for worsening Thyroid Eye Disease. Quitting smoking is one of the most immediate and effective ways to improve your chances of successful treatment.
How can I manage my eye discomfort from TED at home?
You can protect your eyes by using preservative-free artificial tears during the day and applying lubricating eye gels at night. This helps prevent the surface of your eyes from drying out due to swelling or a bulging appearance.
What happens during the inactive phase of TED?
During the inactive phase, the active immune attack, redness, and pain stop. However, structural issues like bulging or double vision may remain due to scarring. At this stage, surgery is often used to restore your eye's appearance and function.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Am I currently in the 'active' or 'inactive' phase of the disease, and how long do you expect my active phase to last?
  2. 2.What is my Clinical Activity Score (CAS), and how does it affect my treatment options today?
  3. 3.Is my thyroid currently euthyroid (stable), and if not, how can we stabilize it to prevent my eye symptoms from worsening?
  4. 4.Based on my current symptoms, do you recommend specialized imaging like an MRI or CT scan to look for muscle swelling or fat accumulation?
  5. 5.Are there support groups or resources you recommend for managing the psychological impact of these facial changes?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (16)
  1. 1

    Management of thyroid eye disease: a Consensus Statement by the American Thyroid Association and the European Thyroid Association.

    Burch HB, Perros P, Bednarczuk T, et al.

    European thyroid journal 2022; (11(6)).

    PMID: 36479875
  2. 2

    An update on thyroid-associated ophthalmopathy in children and adolescents.

    Szczapa-Jagustyn J, Gotz-Więckowska A, Kocięcki J

    Journal of pediatric endocrinology & metabolism : JPEM 2016; (29(10)):1115-1122.

    PMID: 27682712
  3. 3

    Teprotumumab: The First Approved Biologic for Thyroid Eye Disease.

    Hwang CJ, Eftekhari K

    International ophthalmology clinics 2021; (61(2)):53-61 doi:10.1097/IIO.0000000000000353.

    PMID: 33743528
  4. 4

    Teprotumumab for the Treatment of Active Thyroid Eye Disease.

    Douglas RS, Kahaly GJ, Patel A, et al.

    The New England journal of medicine 2020; (382(4)):341-352 doi:10.1056/NEJMoa1910434.

    PMID: 31971679
  5. 5

    Euthyroid Graves' Ophthalmopathy With Negative Antibodies (EGONA): A Comprehensive Case-Based Review.

    Bonny M, Wehbe M, Zaydan R, et al.

    Cureus 2025; (17(12)):e100152 doi:10.7759/cureus.100152.

    PMID: 41602258
  6. 6

    Updates on Treatment in Thyroid Eye Disease for the Neurologist.

    Alryalat SA, Alasheh A, Salim QA, Yaaqba N

    Neurologic clinics 2026; (44(2)):321-335 doi:10.1016/j.ncl.2025.12.002.

    PMID: 41922040
  7. 7

    Pathophysiology of thyroid-associated orbitopathy.

    Lee ACH, Kahaly GJ

    Best practice & research. Clinical endocrinology & metabolism 2023; (37(2)):101620 doi:10.1016/j.beem.2022.101620.

    PMID: 35181241
  8. 8

    Role of teprotumumab in the treatment of active moderate-to-severe Graves' orbitopathy.

    Bartalena L

    European thyroid journal 2022; (11(6)).

    PMID: 36479873
  9. 9

    Emerging therapeutic approaches in graves' ophthalmopathy: an update on pharmacological interventions.

    Wang L, Chen L

    Frontiers in immunology 2025; (16()):1647602 doi:10.3389/fimmu.2025.1647602.

    PMID: 40787463
  10. 10

    Factors associated with the efficacy of intravenous methylprednisolone in moderate-to-severe and active thyroid-associated ophthalmopathy: A single-centre retrospective study.

    Hu S, Wang Y, He M, et al.

    Clinical endocrinology 2019; (90(1)):175-183 doi:10.1111/cen.13855.

    PMID: 30229982
  11. 11

    Current Insights into the Pathogenesis of Graves' Ophthalmopathy.

    Bahn RS

    Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme 2015; (47(10)):773-8 doi:10.1055/s-0035-1555762.

    PMID: 26361262
  12. 12

    Orbital decompression surgery for the treatment of Graves' ophthalmopathy: comparison of different techniques and long-term results.

    Cubuk MO, Konuk O, Unal M

    International journal of ophthalmology 2018; (11(8)):1363-1370 doi:10.18240/ijo.2018.08.18.

    PMID: 30140642
  13. 13

    Quality of life and psychosocial well-being in thyroid eye disease in Japan: pre-teprotumumab national survey.

    Emoto S, Bushita Y, Nagase T, et al.

    Journal of the Endocrine Society 2026; (10(7)):bvag069 doi:10.1210/jendso/bvag069.

    PMID: 42245252
  14. 14

    Related quality of life questionnaire specific to dysthyroid ophthalmopathy evaluated in a population of patients with Graves' disease.

    Delfino LC, Zunino A, Sapia V, et al.

    Archives of endocrinology and metabolism 2017; (61(4)):374-381 doi:10.1590/2359-3997000000252.

    PMID: 28225858
  15. 15

    Thyroid Eye Disease: Advancements in Orbital and Ocular Pathology Management.

    Scarabosio A, Surico PL, Singh RB, et al.

    Journal of personalized medicine 2024; (14(7)) doi:10.3390/jpm14070776.

    PMID: 39064030
  16. 16

    Selenium and Thyroid Disease: From Pathophysiology to Treatment.

    Ventura M, Melo M, Carrilho F

    International journal of endocrinology 2017; (2017()):1297658 doi:10.1155/2017/1297658.

    PMID: 28255299

This page provides an overview of Thyroid Eye Disease for informational purposes only. Always consult your endocrinologist or ophthalmologist for personalized medical advice and treatment planning.

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