How to Test for Thyroid Eye Disease (TED)

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Raymond Douglas, MD PHD

Reconstructive & Aesthetic Oculoplastic Specialist

Do you or someone you love have gritty, dry eyes? Are you experiencing constant eye discomfort? It could be thyroid eye disease (TED).

Thyroid eye disease is a serious autoimmune condition related to Graves’ disease and hyperthyroidism. It causes inflammation and swelling in the tissues around the eyes, leading to inflammation, pain, and vision loss.

What is Thyroid Eye Disease?

TED occurs when the body attacks the muscles and tissues around the eyes, causing inflammation. You may get bulging eyes (proptosis), dry eyes, double vision, and redness. Thyroid eye disease symptoms can range from mild to severe. In some cases, it can cause vision loss.

Testing is important, especially for patients with thyroid disorders. The disease can progress rapidly and cause permanent eye damage. By testing early, patients can get the right treatment and reduce the risk of complications.

Who Should Get Tested?

Early detection is important for thyroid eye disease (TED) but can be tricky to differentiate mild TED symptoms from other conditions like seasonal allergies, smoke/pollution exposure or other conditions.

1. Graves’ Disease Patients and Thyroid Patients

If you have Graves’ disease or another thyroid condition, you are at higher risk of getting TED. TED symptoms usually develop after thyroid dysfunction is diagnosed, so be proactive. Even if you’re already being treated for your thyroid condition, get tested for TED to catch any signs early.

2. Patients with TED symptoms

If you’re experiencing eye symptoms, get tested for TED. What are the first signs of thyroid eye disease? Common symptoms are:

  • Eye irritation or dryness
  • Excessive tearing or watery eyes
  • Redness or swelling around the eyes
  • Light sensitivity
  • Double vision
  • Bulging eyes

If you have a combination of these symptoms, especially if you have thyroid dysfunction, get tested for TED. Ignoring symptoms can lead to worsening of the disease and serious vision problems.

TED tests

Your doctor may use several tests to diagnose TED.

Clinical Eye Exam

A clinical eye exam is the first step in testing for TED. During this exam an ophthalmologist or optometrist will examine your overall eye health. They will look for visible signs of TED such as swelling, redness and bulging eyes. They may measure your eye movement, detect double vision and assess eye alignment.

Visual Acuity Test

The visual acuity test measures your vision sharpness and can detect any damage caused by TED. Changes in your visual acuity, along with other TED symptoms, can indicate the presence of the disease.

Exophthalmometry

Exophthalmometry measures how far your eyes protrude from their sockets, a common sign of TED. A Hertel Exophthalmometer is an instrument used to measure the degree of eye bulging. This test will tell you if the eye bulging is within normal range or if further testing is needed.

Orbital Imaging (CT or MRI Scans)

Orbital imaging, such as CT (computed tomography) or MRI (magnetic resonance imaging) scans, will provide detailed images of the soft tissues, muscles, and nerves behind the eyes. It will help assess the extent of inflammation and tissue damage caused by TED and can also rule out other causes of eye problems, such as tumors or infections.

Blood Tests for Thyroid Function

Blood tests don’t diagnose TED but they do play an important role in confirming thyroid dysfunction, a risk factor for TED. These tests will check the levels of thyroid hormones (T3, T4) and thyroid stimulating hormone (TSH to determine if you have hyperthyroidism, hypothyroidism or another thyroid condition.

How to Prepare for Testing

Getting tested for TED? Here’s what you can do to prepare:

  • Tell your doctor about any known thyroid conditions and if you’re currently being treated. This includes previous diagnoses by other doctors.
  • Bring a list of symptoms and any eye-related issues you’ve experienced. If you can, estimate the severity and duration.
  • Follow fasting instructions if your doctor requires a fasting blood test. Most of the time you’ll need to not eat or drink (except water) for 8-12 hours before the test.

What Do the Results Mean?

The results of TED testing will give your doctor a better understanding of your eye and thyroid health.

Normal

If the results are normal, it means TED is absent, or the symptoms you’re experiencing are not related to TED. However, regular monitoring is still recommended for patients with thyroid conditions, as TED can develop later.

Abnormal

Abnormal results from clinical exams, exophthalmometry, or imaging tests will confirm TED. If TED is diagnosed, your doctor will refer you to an ophthalmologist and an endocrinologist for specialized care. Together, they will create a treatment plan to manage your thyroid condition and TED.

After Diagnosis

Once TED is diagnosed the focus is on managing the disease and preventing its progression. Your thyroid eye disease treatment may include medications to reduce inflammation, thyroid hormone regulation or in severe cases surgery to address eye symptoms. Monitoring is key to tracking the progression of TED and adjusting treatment as needed.

When to Retest or Monitor TED

For patients with ongoing thyroid disease, regular eye health monitoring is a must.

Your condition can change even after an initial TED diagnosis and you may need to adjust your treatment plan. If you’re being treated for thyroid disease (medication or radioactive iodine therapy), you need to continue to have regular eye exams to make sure TED isn’t developing or getting worse.

Call Raymond Douglas’s Office Today to Learn More About TED Testing

Testing and diagnosis early is key to managing TED and preventing long term damage. If you have thyroid disease or are experiencing any of the above symptoms you need to take care of your eye health.

Call Dr. Raymond Douglas’s office to schedule an exam or consult with a specialist to learn more about testing and treatment for TED. Timing is everything when it comes to preserving your vision and overall well-being.

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