How Thyroid Eye Disease Is Diagnosed

Thyroid eye disease is a condition that affects the muscles and tissues of the eyes. The condition happens when you have an overactive thyroid (hyperthyroidism) caused by Graves’ disease. To diagnose thyroid eye disease, you may need a physical exam, lab tests, and imaging tests.

At-Home Testing

There are no official self-checks or at-home tests that can diagnose thyroid eye disease. You have to see a healthcare professional who can do clinical tests to receive an accurate diagnosis. However, understanding your symptoms and checking for some of them at home can help you communicate with your doctor better.

Check for the following symptoms of thyroid eye disease:

• Bulging or protruding eyes
• Dry, red, sensitive, and irritated eyes 
• Vision changes
• Pain or pressure in your eyes
• Problems moving your eyes
• Watery eyes 

Talk to your doctor if you have any of these symptoms or other vision changes. 

Physical Examination

You may begin the process by seeing your primary care physician if you are not diagnosed with hyperthyroidism or Graves’ disease already. Your doctor will do a thorough physical examination. After the initial exam, your primary care physician may recommend seeing a specialist for more testing. You may need to see an:

• Ophthalmologist to check your eyes 
• Endocrinologist to check your hormone levels 
• Internist to check your hormone levels

Physical Exam for the Thyroid 

During a physical exam your doctor will:

• Touch (palpate) your neck to see if the thyroid is larger than normal or if there are nodules.
• Check for increased blood flow in the thyroid, called a thrill, by palpating the area.
• Use a stethoscope to listen to the sound of increased blood flow in the thyroid called a bruit.

The physical exam may also include checking your: 

• Reflexes
• Heart rate and rhythm 
• Blood pressure
• Body temperature 
• Skin
• Nails
• Hair 
• Face
• Tremors or shaking
• Weight 

Eye Exam 

You will need a complete eye examination. An eye doctor can do the following:  

• Test your vision 
• Test your color vision 
• Test visual fields 
• Do eyelid measurements
• Check eye pressure readings
• Check the optic nerves

The eye doctor can also measure the degree of eye-bulging with a device called an exophthalmometer. It can show how far forward your eyes have moved because of thyroid eye disease. 

Labs and Tests

If you do not have a diagnosis of Graves' disease already, your doctor may order laboratory tests to confirm it first. However, you may not need these tests if you know that you have Graves' disease.

You may need blood tests to check the levels of: 

• Thyroid-stimulating hormone (TSH)
• Thyroxine (T4) 
• Triiodothyronine (T3) 
• Thyroid-stimulating immunoglobulin (TSI) 
• Thyroid-stimulating hormone receptor antibody (TRAb)
• Anti-thyroid peroxidase antibody (anti-TPO)

Imaging

If you do not have a diagnosis of Graves' disease already, you may have the following imaging tests:

• Radioactive iodine uptake test with X-rays to check how the thyroid collects iodine 
• Ultrasound of the thyroid to see if it is enlarged or has nodules 
• CT scan to check for an enlarged thyroid and nodules 
• MRI to check for an enlarged thyroid and nodules

If you know that you have Graves' disease, you may have the following imaging tests to check the condition of your eyes and eye muscles:  

• CT scan
• MRI

Differential Diagnoses

It is possible for some of the symptoms of thyroid eye disease to be similar to other conditions, such as orbital tumors (abnormal growths in the socket of the eyes). Your doctor will do multiple tests to confirm your condition.

By combining the results of a physical exam, lab tests, and imaging tests, your doctor can determine if you have thyroid eye disease or something else. 

A Word From Verywell

Talk to your doctor if you have questions about the diagnosis process. Usually, you will need several tests to figure out if you have thyroid eye disease. The process may take less time if you already have a Graves' disease diagnosis. 

It is important to stay patient throughout the diagnosis process. You may need to see specialists, which can take time. Reach out to friends and family for support, so they can help while you wait. 

The right diagnosis is important for receiving the correct treatment and preventing complications that may appear from Graves' disease and thyroid eye disease. You should feel comfortable asking your doctors questions and getting the care you need.