DOES MY PATIENT HAVE THYROID EYE
DISEASE (TED)?

Identify TED sooner by looking for these signs and symptoms

Image representing a specialist talking to his patient about her Thyroid Eye Disease diagnosisIImage representing a specialist talking to his patient about her Thyroid Eye Disease diagnosis

TED can be mistaken for other eye-related conditions such as allergies, conjunctivitis, or Dry Eye Disease (DED). As the disease progresses, patients may notice additional symptoms, creating an ever-increasing burden of disease. These symptoms aren’t always visible, and it’s critical to ask patients if they have had, or are experiencing any of them.1,2

The common signs and symptoms of TED include3-5:

Icon of pressure or pain behind the eye

Proptosis

Icon of eyelid retraction, a common symptom of Thyroid Eye Disease

Eyelid retraction

Icon of diplopia, or double vision, represented by two overlapping pupils

Redness, swelling, and excessive tearing

Icon of proptosis, a common symptom of Thyroid Eye Disease

Dry eyes and grittiness

Icon of photophobia, also known as light sensitivity

Photophobia

Icon of dry, gritty eyes caused by Thyroid Eye Disease

Diplopia

Icon of swelling redness

Pressure and/or pain behind the eyes

restriction of eye movement icon

The feeling of something stuck in the eye

Color vision loss*

Icon of swelling of optic disc icon

Vision loss*

*Affects a small subset of TED patients.

Every patient with Graves’ disease should be screened for TED

Patients with Graves’ disease are at a much higher risk of developing TED. That’s why, according to the American and European Thyroid Associations consensus statement, all Graves’ disease patients should be screened for TED at every visit.6,7

DOWNLOAD A USEFUL CHECKLIST TO HELP IDENTIFY THE SIGNS AND SYMPTOMS OF TED AND WHEN YOUR PATIENT SHOULD CONSULT WITH A TED SPECIALIST.

Early consultation with a TED Specialist can benefit patients

TED is a heterogeneous condition, meaning symptoms may vary from patient to patient. Since TED manifestations can appear similar to other conditions, partnering with a TED Specialist can help with making an accurate diagnosis. They can do this by conducting a comprehensive eye exam, including visual field testing, a slit lamp exam, a Snellen test, and by using an exophthalmometer to measure for proptosis.1,3,4,7,8

For further confirmation, a CT scan or MRI of the eye muscles may be helpful. These scans can show swelling and enlargement in and around the orbit, which can be early signs of TED. There are other diagnostic tools available as well.9,10

Assessing TED activity with the Clinical Activity Score (CAS)

CAS is one of several assessment scales designed to evaluate the signs and symptoms characteristic of inflammatory TED. CAS is typically used in clinical trials and by payors. If used as a marker of disease activity, CAS can be effective for determining whether anti-inflammatory therapy could be prescribed. However, CAS does not account for Thyroid Eye Disease severity.4,6

Patients with a low CAS can develop vision-threatening disease while patients with a high CAS may not progress to a severe disease state. That’s why it’s essential to not only ask your patients about the impact TED has on their lives, but it's also important to co-manage with a TED Specialist—they can help more accurately assess a patient’s disease.6,7

For more information on when to consult with a TED Specialist, reference this guide.

TED IS A COMPLEX DISEASE AND IS RECOMMENDED TO BE CO-MANAGED BY A MULTIDISCIPLINARY TEAM.7

Partner with a TED Specialist to help create a seamless experience throughout your patient’s treatment journey.

Next page > How to Co-manage TED

  1. Couch SM. Thyroid Eye Disease: timely diagnosis is key to controlling this autoimmune condition. Glaucoma Today. January/February 2019. Accessed January 20, 2023. https://assets.bmctoday.net/glaucomatoday/pdfs/0119GT_F2_Couch.pdf
  2. Cockerham KP, Padnick-Silver L, Stuertz N, Francis-Sedlak L, Holt RJ. Quality of life in patients with chronic Thyroid Eye Disease in the United States. Ophthalmol Ther. 2021;10:975-987.
  3. Bahn RS. Graves’ ophthalmopathy. N Engl J Med. 2010;362(8):726-738.
  4. Barrio-Barrio J, Sabater AL, Bonet-Farriol E, Velázquez-Villoria Á, Galofré JC. Graves’ ophthalmopathy: VISA versus EUGOGO classification, assessment, and management. J Ophthalmol. 2015.
  5. Bothun ED, Scheurer RA, Harrison AR, Lee MS. Update on Thyroid Eye Disease and management. Clin Ophthalmol. 2009;3:543-551.
  6. Jain AP, Jaru-Ampornpan P, Douglas RS. Thyroid Eye Disease: redefining its management—a review. Clin Exp Ophthalmol. 2021;49(1):203-211.
  7. Burch HB, Perros P, Bednarczuk T, et al. Management of Thyroid Eye Disease: a consensus statement by the American Thyroid Association and the European Thyroid Association. Thyroid. 2022;32(12):1-32.
  8. Liaboe CA, Clark TJ, Simmons BA, Carter K, Shriver EM. Thyroid Eye Disease: an introductory tutorial and overview of disease. April 23, 2020. Accessed on January 24, 2023. https://eyerounds.org/tutorials/thyroid-eye-disease/index.htm
  9. Dolman PJ. Grading severity and activity in Thyroid Eye Disease. Ophthalmic Plast Reconstr Surg. 2018;34(4S suppl 1):S34-S40.
  10. Kilicarslan R, Alkan A, Ilhan MM, Yetis H, Aralasmak A, Tasan E. Graves’ ophthalmopathy: the role of diffusion-weighted imaging in detecting involvement of extraocular muscles in early period of disease. Br J Radiol. 2015;88(1047):20140677.