Revised 2019

Thyroid eye disease (TED) (or Graves' Orbitopathy) is an autoimmune disorder associated with an over-active thyroid due to Graves' disease (a form of hyperthyroidism). It can affect about a quarter of people with Graves' disease. In most cases it is mild. There is now much that can be done to treat TED. Ask your doctor to refer you to a specialist eye centre that has experience of TED.

Common Symptoms

  • Redness of the eyes or lids
  • Swelling or feeling of fullness in upper or lower eyelids
  • New bags under the eyes
  • Change in the appearance of the eyes (usully staring or bulging eyes)
  • Pain in or behind the eyes, especially when looking up, down or sideways
  • Gritty eyes; or excessive dryness
  • Watery eyes
  • Intolerance of bright light
  • Blurred or double vision
  • Difficulty moving the eyes
  • TED is sometimes misdiagnosed as conjunctivitis, allergy or hay-fever

Risk Factors

  • Smoking increases the risk of getting thyroid eye disease if you have Graves' disease and aggravating the eyes if you already have TED. Treatment is less effective in people who smoke. These risks rapidly disappear in ex-smokers. Your GP surgery will advise you about help you can get to stop smoking. See also information on the BTF website about Smoking and Graves’ disease
  • Fluctuations in thyroid levels, particularly high thyroid stimulating hormone (TSH) i.e. hypothyroidism
  • Radioiodine treatment can worsen TED if you have active TED

Treatments for mild cases

  • Use of effective lubrication including artificial tear drops, gels and ointments
  • Prisms attached to spectacles to help with double vision
  • Selenium supplements

Treatments for more severe cases

  • Steroids to reduce double vision, redness and swelling
  • Steroid treatments combined with other treatments, e.g. immunosuppressive angents and/or radiotherapy for more effective control and to avoid relapse
  • Decompression surgery
  • Eye muscle surgery
  • Eyelid surgery

Other factors

  • TED can affect your psychological and social well-being
  • Don't hesitate to ask your doctor for advice
  • If you experience rapid and severe eye deterioration see your doctor without delay and ask for immediate referral to a specialist eye centre with experience of treating TED.

Further information can be obtained from:
The Thyroid Eye Disease Charitable Trust
PO Box 1928
Bristol BS37 0AX
Helpline 07469 921782
Email: Web:

It is well recognised that thyroid problems often run in families and if family members are unwell they should be encouraged to discuss with their own GP whether thyroid testing is warranted.

If you have questions or concerns about your thyroid disorder, you should talk to your doctor or specialist as they will be best placed to advise you. You may also contact the British Thyroid Foundation for further information and support, or if you have any comments about the information contained in this leaflet.

The British Thyroid Foundation
The British Thyroid Foundation is a registered charity: England and Wales No 1006391, Scotland SC046037

Membership Information
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Endorsed by:

The British Thyroid Association - medical professionals encouraging the highest standards in patient care and research

The British Association of Endocrine and Thyroid Surgeons - the representative body of British surgeons who have a specialist interest in surgery of the endocrine glands (thyroid, parathyroid and adrenal)

First issued: 2008
Revised: 2010, 2011, 2015, 2019
Our literature is reviewed every two years and revised if necessary.

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