Thyroid eye disease (TED) causes inflammation in and around your eyes. If you have symptoms associated with TED or if you’ve been diagnosed with a thyroid condition, such as Graves’ disease, your health care provider may order tests to make a TED diagnosis.

Diagnosing TED may involve a team of health care providers, including:

• Your primary care provider (PCP) — A family doctor or internist
• Ophthalmologists — Doctors who specialize in diagnosing and treating eye disorders
• Optometrists — Health care providers who specialize in caring for your eyes
• Endocrinologists — Doctors who specialize in diagnosing and treating hormone disorders

Continue reading to learn more about five tests for TED.

1. Physical Exam

A physical exam gives your health care provider information about your overall health. It’s important to check your whole body for signs and symptoms of disease because TED can be caused by an autoimmune disorder affecting areas beyond your eyes. An autoimmune disorder is when the body’s defense system, which normally protects it from illness, mistakenly attacks its own tissues.

Your health care provider may perform additional tests based on your medical history and current symptoms.

During a physical exam, your provider will look for signs and symptoms of conditions related to TED.

About 90 percent of people with TED have high levels of thyroid hormones (called hyperthyroidism) when they’re diagnosed. Most often, hyperthyroidism is caused by Graves’ disease — an autoimmune disease in which your immune system attacks your thyroid gland.

Graves’ disease and hyperthyroidism can affect many parts of your body. Your provider may look for the following signs and symptoms during a physical exam:

• Increased heart rate
• Weight loss
• Skin that feels warm and moist
• Excessive sweating
• Thick, bumpy, discolored skin on your shins
• Brittle hair
• Hair loss
• A lump on the front of your neck due to an enlarged thyroid gland
• Muscle weakness

2. Medical History

Your medical history includes information about your health now and in the past. To better understand your medical history, your health care provider will ask about how you’re feeling and any health issues you’ve had in the past.

During this part of the office visit, you can tell your provider about your symptoms that may be related to TED, such as:

• Proptosis (bulging eyes)
• Eyelid swelling
• Double vision
• Dry, irritated eyes
• Watery eyes
• Light sensitivity
• Problems with your vision

Your provider may also ask if you or a family member has ever been diagnosed with a thyroid disease or other autoimmune condition. If you have a family member with TED or another autoimmune disorder, you may have an increased risk of TED.

3. Eye Exam

An eye exam, where your health care provider checks your eyes and eyelids, is a key part of a physical examination. Some TED symptoms can cause permanent damage to your eyesight, so an eye exam is an important step.

An eye exam includes several tests to check the health of your eyes and vision, including:

• Visual acuity test — Your provider asks you to read a series of letters on an eye chart, from biggest to smallest.
• Visual field test — This test checks your peripheral (side) vision. Your provider will ask you how well you see objects in the side of your vision without moving your eyes.
• Eye muscle function test — Your provider checks for problems with your eye muscles by asking you to follow an object with just your eyes.
• Pupil response test — Your provider shines a light into your eyes to see how your pupils react.
• Tonometry test — This test checks the pressure in your eyes.
• Slit-lamp exam — This exam looks at the structure of your eyes up close using a special microscope.

Your health care provider may also perform a dilated eye exam to look for problems inside your eyes. During this test, your provider will place drops in your eyes to dilate (widen) your pupils, allowing a clearer view inside your eyes.

While your pupils are dilated, your provider can use a device called an ophthalmoscope to check the health of different parts of your eye, including the:

• Cornea (the outermost layer of your eye)
• Lens (a clear structure in your eye that helps focus light)
• Retina (a layer of tissue in the back of your eye that processes light signals)
• Optic nerve (the nerve that carries signals from your eye to your brain)
• Blood vessels in your eyes

If your provider suspects you have TED, they will be looking for several different signs during your eye exam, including:

• Blurry vision
• Redness
• Dry eyes
• Difficulty closing your eyelids
• Bulging eyes
• Elevated pressure in your eyes
• Corneal ulcers (sores in your cornea)
• Difficulty moving your eyes, causing double vision
• Changes in your optic nerve

4. Blood Tests

Blood tests can be helpful to diagnose problems with your thyroid that may be connected to TED. Almost 20 percent of people with TED start experiencing eye symptoms before they’re diagnosed with Graves’ disease.

Blood tests that help check your thyroid function include tests for thyroid-stimulating hormone (TSH), thyroid hormones, and thyroid antibodies.

TSH Test

TSH is a hormone that tells your thyroid how much thyroid hormone to release.

A high TSH level usually means your thyroid isn’t releasing enough thyroid hormones (hypothyroidism). In response to low thyroid hormone levels, your body makes more TSH to encourage your thyroid to make more thyroid hormones.

A low TSH level usually means your thyroid is making too much thyroid hormone (hyperthyroidism). If you already have too much thyroid hormone, your body doesn’t make as much TSH. People with Graves’ disease usually have a low TSH level.

Thyroid Hormone Tests

A thyroid hormone test checks the level of thyroid hormones in your blood.

There are two types of thyroid hormones — thyroxine (T4) and triiodothyronine (T3). T4 is the main thyroid hormone in your blood.

If your thyroid hormone levels are too high, it means you have hyperthyroidism. If your thyroid hormone levels are too low, it means you have hypothyroidism.

Thyroid Antibody Test

A thyroid antibody test checks for immune system proteins called antibodies that can cause autoimmune thyroid disease.

If you have Graves’ disease, you may test positive for thyroid-stimulating immunoglobulins and thyrotropin-binding inhibitor immunoglobulins.

If you have Hashimoto’s thyroiditis, you may have antithyroid antibodies that cause hypothyroidism.

5. Imaging Tests

Your health care provider may order different imaging tests to get an image of your eye.

CT Scan

A CT scan uses X-ray and computer technology to create a detailed view of the inside of your body. This type of scan can help your providers see if you have abnormally large muscles in your eye that could be pressing on your optic nerve.

MRI Scan

An MRI scan uses a magnetic field and radio waves to create an image of the inside of your body. This type of scan helps providers determine how severe TED is by looking at the swelling of the tissues around your eye.

Ultrasound

Ultrasound uses sound waves to create a picture of the tissues inside your body. Like MRI scans, this type of test can help determine how severe TED is by looking at swelling in the tissues around your eye.

An ultrasound of your thyroid (called a Doppler ultrasound) can help diagnose Graves’ disease by looking for increased blood flow to your thyroid.

Radioactive Iodine Uptake Test

A radioactive iodine uptake test checks for Graves’ disease by looking at how much radioactive iodine your thyroid absorbs after you get a dose of radioactive iodine. If your thyroid absorbs a high level of radioactive iodine, it may be a sign that you have Graves’ disease.

If you’re experiencing symptoms of TED or have a related condition like Graves’ disease, your health care provider will use various tests to properly diagnose TED. Getting the right diagnosis is key to finding the best treatment plan for you. This approach helps manage your symptoms effectively and keeps your eyes healthy.

Talk With Others Who Understand

On TEDhealthteam, the social network for people living with thyroid eye disease and their loved ones, members come together to ask questions, give advice, and share their stories with those who understand life with TED.

Are you or a family member living with TED? How were you diagnosed with TED? Share your experience in the comments below, or start a conversation by posting on your Activities page.