How to Test for Thyroid Eye Disease (TED)

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 dryiness
• Excessive tearing or watery eyes
• Redness or swelling around the eyes
• Light sensitivity
• Double vision
• Bulging eyes (proptosis)
• Eye pain or discomfort
• Feeling of pressure behind the eyes
• Difficulty closing eyelids completely
• Changes in vision or color perception

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.

Thyroid Eye Disease 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 (Thyroid Eye Disease) 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.

Your doctor may also test for Thyroid-Stimulating Immunoglobulin (TSI) antibodies, which are often present in Graves’ disease and can help explain the autoimmune process behind TED.

It’s important to understand that TED can develop even when your thyroid hormone levels are completely normal. This means you can’t rely on thyroid blood tests alone to rule out TED. Some patients develop TED months or even years after their thyroid levels have been successfully treated and normalized. This is why comprehensive eye exams and imaging tests are crucial for proper diagnosis, regardless of what your thyroid blood work shows.

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 (Thyroid Eye Disease) 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.

Other Important Questions to Consider

What additional eye tests might my doctor perform?

Beyond examining your eyes visually, your doctor may perform several specialized tests. They’ll check the pressure inside your eyes (intraocular pressure) since TED can cause dangerous increases that threaten vision. Visual field testing maps your peripheral vision to detect if swollen tissues are compressing your optic nerve. Color vision testing can reveal subtle optic nerve damage, and detailed eye movement assessments help identify which specific muscles are affected by the inflammation.

Can I have thyroid eye disease even if my thyroid levels are normal?

Yes, this is a crucial point many patients don’t realize. TED can develop even when your thyroid hormone levels (TSH, T3, T4) are completely normal. Your doctor may also test for Thyroid-Stimulating Immunoglobulin (TSI) antibodies, which are often present in Graves’ disease and can help explain why TED developed. This is why comprehensive eye exams and imaging are so important for diagnosis – you can’t rely on thyroid blood tests alone.

Does the testing approach change depending on how long I’ve had thyroid eye disease?

Yes, TED typically follows two distinct phases, and testing focuses on different aspects for each. During the active inflammatory phase (usually the first 1-3 years), imaging tests like MRI or CT scans are particularly important to assess ongoing swelling and inflammation in your eye muscles and tissues. In the stable phase, testing shifts to evaluating lasting effects like double vision, eye alignment problems, or permanent changes in eye position that might require different treatments.

How do doctors determine the severity and specific type of eye muscle problems in TED?

Doctors use specialized techniques to assess exactly which eye muscles are affected and how severely. They’ll test your eye movements in all directions to map muscle weakness or restriction, measure the degree of eye misalignment that causes double vision, and evaluate whether the muscles are inflamed and swollen or have developed permanent scar tissue. This detailed assessment, combined with imaging, helps determine whether you need anti-inflammatory treatment or surgical correction.

Call Raymond Douglas’s Office Today to Learn More About Thyroid Eye Disease 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.