Thyroid Eye Disease (TED)

Symptoms to watch for

TED frequently starts subtly. If you have any thyroid disorder and notice these symptoms, get evaluated quickly — there's a window where treatment is most effective.

• Eye bulging (proptosis)
• Eyelid retraction or a "startled" appearance
• Dry, gritty, or watery eyes
• Pain behind the eyes, especially with movement
• Double vision (diplopia)
• Light sensitivity
• Vision changes — color desaturation, blurred or reduced vision (urgent)

How we diagnose and stage

TED has an active phase (months to a few years) and an inactive phase. The treatment that works during the active phase is very different from what works after — so accurate staging is essential.

• Clinical Activity Score (CAS) — A standardized exam tool to assess inflammation.
• Comprehensive thyroid panel — Including TSI/TRAb antibodies.
• Orbital imaging — CT or MRI when surgical planning or severity assessment is needed.
• Coordinated ophthalmology referral — For oculoplastics, neuro-ophthalmology, or strabismus expertise.

Treatment options

• Tepezza (teprotumumab) — The first FDA-approved medication that actually treats the underlying disease — we coordinate referral and management.
• Selenium — Mild-disease support backed by clinical evidence.
• Corticosteroids — For active inflammation, oral or IV.
• Orbital decompression surgery referral — For severe disease or after the active phase.
• Strabismus & eyelid surgery referral — For double vision or cosmetic correction once stable.

Why an endocrinologist matters

TED sits at the intersection of thyroid disease and ophthalmology. Treating the thyroid disorder properly — and aggressively, when needed — directly affects the eye disease. We coordinate the whole picture so neither side is treated in isolation.