SYMPTOMS OF TED

Thyroid Eye Disease (TED) is progressive, and early intervention has been shown to reduce disease impact1,2

Early signs and symptoms of TED may include1,2

Icon of proptosis, a common symptom of Thyroid Eye Disease Icon of proptosis, a common symptom of Thyroid Eye Disease Icon of proptosis, a common symptom of Thyroid Eye Disease

Proptosis

Proptosis is caused by expansion of the orbital fat and muscles behind the eyes. The lacrimal glands are frequently involved and enlarged, causing bulging of the eye. Proptosis is one of the most common symptoms of TED.3

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

Diplopia

Diplopia is caused by swelling and inflammation of the extraocular muscles and typically restricts the movement of the eye, causing double vision. The most frequently involved muscle is the inferior rectus.4

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

Eyelid
retraction

Upper eyelid retraction develops from levator and Müller muscle inflammation and fibrosis or from levator muscle overaction caused by inferior rectus restriction. Symptomology overlaps between Graves’ disease and TED. Upper eyelid retraction is one of the most common symptoms of TED.3,4

Icon of pressure or pain behind the eye Icon of pressure or pain behind the eye Icon of pressure or pain behind the eye

Pressure and/or pain behind the eyes

TED causes an increase in the orbital soft tissue volume, which leads to a higher pressure within the inexpandable bone cavity.3

Icon of photophobia, also known as light sensitivity Icon of photophobia, also known as light sensitivity Icon of photophobia, also known as light sensitivity

Photophobia

Photophobia, or light sensitivity, often occurs in TED patients when the upper eyelid retracts, resulting in corneal exposure. Evidence shows that up to 80% of patients develop upper eyelid retraction in early TED.1,5

Icon of dry, gritty eyes caused by Thyroid Eye Disease Icon of dry, gritty eyes caused by Thyroid Eye Disease Icon of dry, gritty eyes caused by Thyroid Eye Disease

Dry eyes and grittiness

Dry eyes and grittiness are frequently under-recognized signs of TED.6 In a long-term follow-up study in a single US county, 72% of patients with TED said dry eyes were their most frequent source of eye discomfort.7 These symptoms are often misdiagnosed as allergies or conjunctivitis.8

Icon of eye redness, swelling and excessive tearing caused by Thyroid Eye Disease Icon of eye redness, swelling and excessive tearing caused by Thyroid Eye Disease Icon of eye redness, swelling and excessive tearing caused by Thyroid Eye Disease

Redness, swelling, and excessive tearing

Erythema (redness) and edema (swelling) of the eyelids were the 2 most commonly reported signs in a pilot study of a tool designed to help non-eye specialists detect early TED.1 Corneal exposure due to eyelid retraction can lead to excessive reflex tearing.3,5

If you notice any changes or worsening symptoms it is important to consult with a TED Specialist quickly.3 Thyroid Eye Disease is a progressive, chronic, potentially vision-threatening autoimmune disease, and co-managing can change the course of TED3,9

Dr Smith Thumbnail

TED SYMPTOMS ARE CAUSED BY THE STIMULATION OF ORBITAL FIBROBLASTS, WHICH CAUSES INFLAMMATION BEHIND THE EYE.4

Watch a video about TED’s unique mechanism of disease (MOD), its symptoms, and the importance of early diagnosis, featuring Dr Terry Smith, professor of ophthalmology and visual sciences and professor of internal medicine.

READ TRANSCRIPT

TED is separate and distinct from Graves’ disease, and requires different treatment4,9-14

THYROID EYE DISEASE (TED) GRAVES’ DISEASE
THYROID EYE DISEASE (TED)
AFFECTED AREAS

Front and back of the eyes

Thyroid

DISEASE MANIFESTATIONS

Ocular myositis and expansion of orbital fat

Hyperthyroidism

COMMON SYMPTOMS
  • Proptosis
  • Diplopia and other vision changes
  • Eyelid retraction
  • Ophthalmalgia, including pain around and behind the eyes
  • Keratoconjunctivitis
  • Erythema and edema of eyelids
  • Epiphora
  • Photophobia
  • Tachycardia
  • Irritability
  • Anxiety
  • Fatigue
  • Hyperhidrosis, heat sensitivity
TREATMENT
OPTIONS
  • FDA-approved IGF-1R inhibitor
  • Glucocorticoids (steroids)
  • Topical treatments (ie, lubricating eye drops)
  • Surgical procedures (ie, orbital and bony decompression surgery)
  • Radioactive iodine
  • Antithyroid drugs
  • Beta blockers
  • Thyroidectomy
GRAVES’ DISEASE
AFFECTED AREAS

Thyroid

DISEASE MANIFESTATIONS

Hyperthyroidism

COMMON SYMPTOMS
  • Tachycardia
  • Irritability
  • Anxiety
  • Fatigue
  • Hyperhidrosis, heat sensitivity
TREATMENT OPTIONS
  • Radioactive iodine
  • Antithyroid drugs
  • Beta blockers
  • Thyroidectomy

TED is a heterogenous condition, meaning symptoms may vary from patient to patient.9
TED manifestations are often misdiagnosed as allergies or conjunctivitis. Misdiagnoses of TED symptoms can lead to significant delays in treatment. It’s important to ask your patients if they are experiencing any new or worsening symptoms of TED.3,8,15

CONSULT WITH A TED SPECIALIST…

to co-manage your patients together.3

  1. Mitchell AL, Goss L, Mathiopoulou L, et al. Diagnosis of Graves’ orbitopathy (DiaGO): results of a pilot study to assess the utility of an office tool for practicing endocrinologists. J Clin Endocrinol Metab. 2015;100(3):E458-E462. doi:10.1210/jc.2014-3146
  2. Bothun ED, Scheurer RA, Harrison AR, Lee MS. Update on thyroid eye disease and management. Clin Ophthalmol. 2009;3:543-551. doi:10.2147/opth.s5228
  3. 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;2015:249125. doi:10.1155/2015/249125
  4. Bahn RS. Graves’ ophthalmopathy. N Engl J Med. 2010;362(8):726-738. doi:10.2147/TCRM.S193018
  5. Dolman PJ. Grading severity and activity in thyroid eye disease. Ophthalmic Plast Reconstr Surg. 2018;34(4S Suppl 1):S34-S40. doi:10.1097/IOP.0000000000001150
  6. Bartley GB, Fatourechi V, Kadrmas EF, et al. Long-term follow-up of Graves ophthalmopathy in an incidence cohort. Ophthalmology. 1996;103(6):958-962. doi:10.1016/s0161-6420(96)30579-4
  7. Bartley GB. The epidemiologic characteristics and clinical course of ophthalmopathy associated with autoimmune thyroid disease in Olmsted County, Minnesota. Trans Am Ophthalmol Soc. 1994;92:477-588.
  8. Estcourt S, Hickey J, Perros P, Dayan C, Vaidya B. The patient experience of services for thyroid eye disease in the United Kingdom: results of a nationwide survey. Eur J Endocrinol. 2009;161(3):483-487. doi:10.1530/EJE-09-0383
  9. Wang Y, Patel A, Douglas RS. Thyroid eye disease: how a novel therapy may change the treatment paradigm. Ther Clin Risk Manag. 2019;15:1305-1318. doi:10.2147/TCRM.S193018
  10. Smith TJ, Hegedüs L. Graves’ disease. N Engl J Med. 2016;375 (16):1552-1565. doi:10.1056/NEJMra1510030
  11. Bruscolini A, Sacchetti M, La Cava M, et al. Quality of life and neuropsychiatric disorders in patients with Graves’ orbitopathy: current concepts. Autoimmun Rev. 2018;17(7):639-643. doi:10.1016/j.autrev.2017.12.012
  12. US Food and Drug Administration. FDA approves first treatment for thyroid eye disease. January 21, 2020. Accessed August 16, 2021. https://www.FDA.gov/news-events/press-announcements/fda-approves-first-treatment-thyroid-eye-disease
  13. Wiersinga WM. Graves’ disease: Can it be cured? Endocrinol Metab (Seoul). 2019;34(1):29-38. doi:10.3803/EnM.2019.34.1.29
  14. Graves’ disease. Mayo Clinic. Accessed August 23, 2021. https://www.mayoclinic.org/diseases-conditions/graves-disease/symptoms-causes/syc-20356240
  15. Konuk O, Anagnostis P. Diagnosis and differential diagnosis of Graves’ orbitopathy. In: Wiersinga WM, Kahaly GJ, eds. Graves’ orbitopathy: A Multidisciplinary Approach - Questions and Answers. 3rd ed. S Karger AG; 2017:74-92