Thyroid Eye Disease (TED) or Graves Orbitopathy (GO)
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Thyroid Eye Disease (TED) or Graves
Orbitopathy (GO)
This leaflet has been produced to remind you of what you have been told in the Eye
Clinic and to give a fuller explanation of how Thyroid Eye Disease can be managed.
What is Thyroid Eye Disease (TED) or Graves Orbitopathy (GO)?
A small proportion of people who have overactive thyroid glands have problems with
their eyes. It is also possible to have eye problems when the thyroid changes from
over to underactive, or even when the thyroid blood tests appear normal.
Thyroid dysfunction can cause several different problems with the eyes:
In the mildest form there is some puffiness of the lids together with a
combination of a dry scratchy sensation and excess watering.
The eyes may be pushed forwards due to swelling and inflammation in the
orbit (eye socket).
The eye muscles may also be inflamed resulting in double vision, often
first noticeable when looking up.
Very rarely there may be sight threatening damage to the front of the eye
due to the eye being pushed forwards and exposed.
The eye nerve which connects the eye to the brain may be squeezed due
to pressure in the orbit and this can severely affect vision.
Treatment Plan:
TED is a self-limiting disease and, in most patients, settles down after two
to three years.
If left untreated, the inflammation will gradually go by itself. However, the
physical changes caused by the swelling (such as the eyes being pushed
forward) may remain. This is because some of the tissues that have been
stretched may not always return to their original form.
The aim of treatment is mainly to limit inflammation and swelling occurring
during the inflamed (active) period and to protect the surface of the eye.
There are also treatments for people whose tissues have not been able to
return to their original form after the inflammation has settled (inactive
period).
The most important factor in the treatment of TED is to make the thyroid
gland work normally again. This is done using the medication prescribed
by your Endocrinologist or General Practitioner (GP). This usually works
Patient Thyroid Eye Disease (TED) or Graves Orbitopathy
Information
(GO)
well if taken regularly but additional surgery or radioactive iodine may be
effective if necessary.
Blood tests to monitor the function of the thyroid are needed regularly, as
suddenly having low thyroid function can make eye problems worse.
Smoking
There is a significant evidence base linking smoking to increased severity of TED
and decreased effectiveness of treatment.
EUGOGO: Consensus Statement on the Management of Graves Orbitopathy.
European Journal of Endocrinology 2008; 158: 273 – 285
You should stop smoking or reduce your smoking as much as possible.
For help and advice on how to quit smoking see contact details below.
Options you can discuss with your Ophthalmologist:
Eye lubricants
In TED the eyes are often dry as blinking is incomplete and if the eye is pushed
forward it is less protected. However, this can make the eyes water and produce
more tears than normal as a reflex response.
Lubricant eye drops, and ointment are helpful. These are available over the
counter from any chemist but may be prescribed by the Ophthalmologist if
significant problems exist. Use them 4-8 times a day, with ointment at night
especially if the lids are not tightly closed whilst sleeping.
Steroids
Patients with severe TED may benefit from a course of high dose intravenous
steroids. The steroids are depending on the response. The steroids can reduce
the swelling round the eyes. Risks of steroids include bleeding from the bowel,
thinning of the bones, increased appetite, and water retention.
Prisms
For patients who have double vision, prisms on glasses can be very helpful. The
Orthoptist, who assesses and monitors binocular vision problems in the Eye
Clinic, will determine your suitability for prisms. These are plastic films which stick
to your glasses with water. They are more suitable than prisms incorporated into
your lenses by an optician because they can be adjusted easily as your double
vision changes.
You must not drive if you have double vision.
You are required to inform the DVLA that you have double vision even if
your double vision is controlled by prisms or an occluding eye patch.
Page 2 of 5Patient Thyroid Eye Disease (TED) or Graves Orbitopathy
Information
(GO)
Surgery
For patients who have more severe Thyroid Eye Disease, surgery to the lids can
improve the appearance or occasionally orbital decompression can allow the
eyes to sink back into the socket.
Surgery to the eye muscles for double vision, to the lids or to the orbit is usually
only undertaken when the disease is under control. There is a good chance that
most TED will settle without surgery.
Selenium supplements
There is conflicting advice as to whether there is any benefit in taking this dietary
supplement. It has been used at a dosage of 100mcg twice daily. Selenium
supplements cannot be prescribed by the Ophthalmologist but can be bought
over the counter at your chemist. People who eat meat, fish, eggs, or Brazil nuts
should be able to get all the Selenium they need from a balanced healthy diet.
The recommended adult daily allowance is 55 mcg which is less than the amount
in one large Brazil nut. No more than one or two Brazil nuts should be consumed
daily to avoid excessive accumulation of Selenium in the body.
Too much Selenium can be harmful causing bad breath and affecting the heart,
liver, and kidneys. It can also interact with other medicines such as antacids,
chemotherapy drugs, corticosteroids, niacin, cholesterol lowering statin drugs and
oral contraceptives. Do not take if you are at high risk of non-melanoma skin
cancer.
If you develop any of the following symptoms contact the Eye Clinic for advice
(see contact details at the end of this leaflet).
Your symptoms get increasingly worse over a period of several days
or weeks.
You have blurred vision which does not improve by blinking or
covering each of the two eyes in turn.
You become aware that colours do not appear as bright as they used
to or there is a difference in how bright colours seem when you
compare one eye with the other.
You see double looking forwards or downwards or need to keep your
head tilted sideways or backwards to avoid seeing double.
Page 2 of 5Patient Thyroid Eye Disease (TED) or Graves Orbitopathy
Information
(GO)
Contact Details:
Eye Outpatient Clinic, Great Western Hospitals NHS Foundation Trust,
Swindon. SN3 6BB
Urgent Eye Outpatients: Telephone 01793 604868
Monday - Friday 9am – 9pm,
Saturday, Sunday, and Bank Holidays 9am – 1pm.
Orthoptic Department:
Telephone/answerphone 01793 604702 Monday- Friday 8am – 5pm
Other Useful Contacts:
British Thyroid Foundation: www.btf-thyroid.org
Thyroid Eye Disease Charitable Trust:
PO BOX 1928,
Bristol BS37 0AX, UK
www.tedct.org.uk email info@tedct.org.uk
Helpline & support: 07469921782 or TEDct,
For advice about how to stop smoking:
Swindon Stop Smoking Service is free and helps many people to quit for good.
Find out more by calling the Live Well Swindon Hub on 01793 465513
Monday - Thursday 9am - 5pm and Friday 9am-4.30pm (closed Bank Holidays) or
Text 07881 281797 and they will call you back during service hours.
Email: livewell@swindon.gov.uk or livewellswindon@nhs.net.
Smokefree Wiltshire: Health Trainer Service
The health trainers can help you reduce or stop smoking and help
you make other positive lifestyle changes. This service is for people
aged 18+ and is free. For more information email: health.trainers@wiltshire.gov.uk
Tel: 0300 0034566 Website: www.wiltshire.gov.uk/public-health-trainers
Most GP surgeries and many Pharmacies can also help you stop smoking. For more
information visit www.wiltshire.gov.uk/smokefree
Email:wiltsstopsmoking@nhs.net
Page 2 of 5Patient Thyroid Eye Disease (TED) or Graves Orbitopathy
Information
(GO)
Free National Smokefree Helpline: Freephone 0800 0224 332 Monday - Friday
9am - 8pm, Saturday - Sunday 1am - 5pm. or visit www.smokefree.nhs.uk
Smoking will not be permitted on any NHS site in England. Smoking will not be permitted within any of our
buildings or anywhere outside on our sites. Smoking facilities will not be provided. Please be considerate of
others when vaping in hospital grounds.
This information sheet is available to order in other
languages and formats. If you would like a copy, please
contact us on 01793 604031 or email gwh.pals@nhs.net
Document Control
Division: Surgery, Women and Children’s
Department: Ophthalmology
Approved Date: 14 April 2021
Next Review Date: May 2024
Document Number: SW&C - PIL0040
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