Thyroid eye disease

Thyroid eye disease (TED) - also called Graves' orbitopathy - is an autoimmune condition in which the immune system attacks the muscles, fat, and connective tissue behind and around the eyes.

It most commonly occurs alongside Graves' disease, but can occasionally occur in Hashimoto's or in people with normal thyroid function. TED and Graves' disease often follow separate timelines - TED can worsen even when thyroid levels are well controlled, and can sometimes appear or flare after radioactive iodine treatment.

Symptoms range from mild to severe and include: grittiness or irritation of the eyes, puffiness and swelling around the eyes, redness, light sensitivity, a sensation of pressure behind the eyes, and in more significant cases bulging of the eyes (proptosis), double vision, and rarely compression of the optic nerve affecting sight.

Smoking is the single biggest modifiable risk factor for TED and significantly increases severity. Keeping thyroid levels well controlled also matters. TED is managed by specialist teams that often include ophthalmologists working alongside endocrinologists. Active TED may be treated with steroid infusions, selenium (for mild active disease), orbital decompression surgery, or targeted biological treatments.