Thyroid eye disease (TED) is also known as Graves’ orbitopathy or Graves’ ophthalmopathy. Around a third of people with Graves’ disease will develop symptoms of eye disease.

Graves’ disease and TED are both autoimmune conditions. The immune system is designed to detect things that don’t belong in the body. When it detects an invader, it launches an attack. This is helpful when the target is a virus or bacteria, but when the immune system mistakenly attacks part of the body, we call it an autoimmune disease.

In Graves’ disease, the immune system damages the thyroid, a gland at the front of your neck. This causes an overproduction of thyroid hormones, resulting in hyperthyroidism. Symptoms of hyperthyroidism include rapid heart rate and trouble sleeping.

Eye symptoms can also occur as part of Graves’ disease. The immune system mistakenly targets tissue behind the eyes, causing thyroid eye disease.

If you have Graves’ disease, your healthcare team may tell you to watch for any changes in your eyes. In some cases, TED is the first sign of hyperthyroidism. But it can occur when thyroid levels are high, normal, or even in the low range.

Signs and symptoms of TED include:

  • eye swelling and redness
  • the sensation of grit in the eye, leading to excessive tearing
  • dry eyes
  • light sensitivity
  • eyelid swelling
  • changes in vision, including double vision
  • visual bulging of the eyeball
  • aching or discomfort in the eye when looking to the side or upwards

The tissues and muscles in your eyes will be checked for signs of swelling. MRI or CT scans may be done to get a more in-depth look.

Thyroid eye disease is most likely to occur within 6 months of a diagnosis of Graves’ disease. However, TED can occur in Graves’ patients with normal or even low thyroid levels.

While it commonly occurs with Graves’ disease, TED can occur with Hashimoto’s thyroiditis, a hypothyroid condition. TED isn’t directly linked to high thyroid levels.

Sometimes, TED is the first sign of any thyroid problem. However, higher thyroid levels won’t cause a more severe case of thyroid eye disease.

Autoimmune diseases remain a mystery. It’s not clear what causes the body to attack healthy cells.

Smoking or spending a lot of time with someone who smokes can increase the risk for TED. If you already have TED, smoking can make symptoms worse.

Thyroid eye disease is associated with hyperthyroidism, not hypothyroidism.

After a diagnosis of Graves’ disease, it can take time to manage thyroid hormone levels. Sometimes, treatment for Graves’ disease causes thyroid levels to drop too low.

Thyroid eye disease can develop when thyroid levels are high, in the target range, or low. Close monitoring of thyroid levels is important as part of managing Graves’ disease.

Graves’ disease and TED are part of the same condition, but they follow their own courses. In some cases, thyroid eye disease may occur before a diagnosis of Graves’ disease.

You may have different specialists involved in your care. It will depend on the presence and severity of any eye symptoms.

You may already be working with an endocrinologist to manage your thyroid condition. An endocrinologist specializes in hormones, including those produced by the thyroid. You’ll have regular blood work to monitor your thyroid levels.

If you have signs and symptoms of TED, an eye specialist can help. You may be referred to an ophthalmologist. This kind of eye specialist can help if further treatment or surgery is needed.

Around a third of people with Graves’ disease develop thyroid eye disease. Graves’ disease and TED are both part of the same autoimmune condition.

Symptoms can include irritation, swelling, and bulging appearance of the eyeball. Make note of any changes to your eyes, and talk to your healthcare team if you have any concerns.