Thyroid eye disease (TED), also called Graves' eye disease, Graves' ophthalmopathy, or Graves' orbitopathy, is an autoimmune condition in which inflammation affects the tissues and muscles surrounding the eyes.
It most often occurs in people with Graves' disease and an overactive thyroid, but thyroid eye disease can also develop when thyroid hormone levels are normal or, less commonly, low.
Symptoms may include dry or gritty eyes, redness, swelling around the eyes, light sensitivity, pressure or pain behind the eyes, eyelid retraction, bulging eyes, and double vision. In more severe cases, swelling within the eye socket can threaten vision.
Fortunately, mild thyroid eye disease often improves over time. Several natural and supportive measures may also reduce irritation, swelling, and other symptoms. Among supplements, selenium has the strongest clinical evidence for mild, active TED.
Medical Disclaimer: Thyroid eye disease can occasionally threaten eyesight and should be evaluated by an ophthalmologist, ideally one experienced in TED. Natural remedies should be considered supportive care rather than substitutes for appropriate medical treatment. Seek prompt medical attention for decreased vision, changes in color vision, severe eye pain, inability to close the eyelids, new or worsening double vision, or rapidly increasing eye protrusion.
1. Selenium
Selenium is the natural supplement with the best evidence for thyroid eye disease.
Selenium is an essential trace mineral required for antioxidant enzymes and normal thyroid function. Because oxidative stress and autoimmune inflammation are involved in TED, researchers have investigated whether selenium can influence the course of the disease.
A landmark randomized, double-blind clinical trial involving people with mild Graves' orbitopathy found that selenium improved quality of life and eye symptoms and reduced the likelihood that the disease would progress.
Participants received selenium for six months, and some benefits remained after supplementation was discontinued.
European thyroid guidelines subsequently recommended a six-month course of selenium for people with mild, active, relatively recent Graves' orbitopathy, particularly in areas where selenium intake is low.
Typical Amount Studied
The major European trial used sodium selenite providing approximately 100 mcg of elemental selenium per day.
Some guidelines and clinical discussions use selenium preparations in the range of 100 to 200 mcg daily, depending on the form of selenium and the person's selenium status.
Important Caution
More selenium is not better. Chronic excessive selenium can cause hair loss, brittle nails, gastrointestinal symptoms, fatigue, metallic taste, or a garlic-like odor to the breath.
The tolerable upper intake level for adults should not be treated as a target dose. Selenium from supplements should also be considered together with dietary sources such as Brazil nuts, which can contain surprisingly large and highly variable amounts.
Evidence is also much less convincing that selenium helps people who already have adequate selenium intake or those with moderate-to-severe TED.
Research Snapshot: Selenium is the best-studied nutritional intervention for mild thyroid eye disease. A randomized controlled trial found improvements in eye involvement and quality of life and less disease progression after six months of supplementation.
What to Know: Selenium appears most appropriate for mild, active TED and may be particularly helpful when selenium intake is low. High-dose selenium should be avoided unless specifically recommended by a healthcare professional.
2. Keep Thyroid Levels Stable
Although this is not technically a remedy, maintaining normal and stable thyroid hormone levels is one of the most important steps a person with thyroid eye disease can take.
Both hyperthyroidism and hypothyroidism can worsen TED.
Someone treating Graves' disease naturally should therefore be particularly careful about allowing thyroid levels to remain substantially elevated for long periods. Likewise, treatment that pushes thyroid function too low is undesirable.
Regular monitoring of TSH, free T4, and sometimes free T3 is important while TED is active.
Thyroid-stimulating hormone receptor antibodies, commonly called TRAb or TSHR-Ab, may also be useful because high antibody levels are associated with a greater risk of thyroid eye disease.
What to Know: Eye symptoms can worsen when thyroid hormone levels are either too high or too low. Stable thyroid function is an important part of TED management even when the eye symptoms seem separate from thyroid symptoms.
3. Avoid Cigarette Smoke Completely
Smoking is one of the clearest modifiable risk factors for thyroid eye disease.
People who smoke have a substantially greater risk of developing TED, and existing eye disease is more likely to become severe. Secondhand cigarette smoke should also be avoided.
For someone looking for natural ways to stop TED from progressing, eliminating tobacco smoke may be considerably more important than adding another supplement.
Research Snapshot: Smoking is strongly associated with both the development and worsening of thyroid eye disease. Smoking cessation is considered one of the most important lifestyle interventions for people with Graves' orbitopathy.
4. Cold Compresses
A simple cool compress can provide considerable relief when the eyelids and tissues around the eyes feel swollen, hot, or irritated.
Soak a clean washcloth in cool water, wring it out, and place it gently over closed eyes for approximately 5 to 10 minutes.
Do not apply ice directly to the eyelids or eyeballs.
Cold compresses will not stop the autoimmune process responsible for TED, but they can provide inexpensive symptomatic relief during inflammatory flares.
5. Lubricating Eye Drops
Dryness and a persistent sandy or gritty sensation are among the most common symptoms of thyroid eye disease.
As the eyes protrude and the eyelids retract, a greater portion of the eye's surface becomes exposed to air. Some people also stop closing their eyelids completely when blinking or sleeping.
Preservative-free artificial tears can be particularly helpful when drops must be used frequently.
At night, a lubricating eye gel or ointment lasts longer than ordinary drops and may help protect the cornea while sleeping.
Despite the word "artificial," lubricating drops are essentially supportive moisture therapy rather than medication directed at the autoimmune disease.
Avoid routinely using "get the red out" vasoconstrictor drops as a substitute for lubrication unless an eye doctor recommends them.
What to Know: If eye drops are needed several times a day, preservative-free formulas may be less irritating. Nighttime gels or ointments can be especially useful if the eyelids do not close completely during sleep.
6. Sleep With Your Head Elevated
TED commonly causes fluid accumulation and puffiness around the eyes, which can be particularly noticeable in the morning.
Sleeping with the head elevated may reduce overnight fluid accumulation and orbital congestion.
Try a wedge pillow or raise the head of the bed rather than simply bending the neck forward with several soft pillows.
Even a modest elevation may make morning puffiness more manageable.
7. Omega-3 Fatty Acids
Omega-3 fatty acids are interesting for TED primarily because of their anti-inflammatory properties and their established role in ocular surface health.
EPA and DHA may help some forms of dry-eye symptoms, although research has produced mixed results, and omega-3 supplementation has not been established as a treatment for thyroid eye disease itself.
Vegetarians can obtain DHA and EPA directly from algae-derived omega-3 supplements rather than fish oil.
Foods providing the omega-3 fatty acid ALA include:
- Ground flaxseed
- Chia seeds
- Walnuts
- Hemp seeds
Consider omega-3s primarily as nutritional support rather than a replacement for proven TED treatment.
What to Know: Omega-3 fats may support tear quality and general eye health, but they have not been proven to stop or reverse thyroid eye disease.
8. Eat an Anti-Inflammatory, Antioxidant-Rich Diet
Oxidative stress appears to participate in the inflammatory processes involved in thyroid eye disease.
For that reason, a diet rich in naturally occurring antioxidants is reasonable even though no particular "TED diet" has been proven to reverse the disease.
Emphasize foods such as:
- Berries
- Dark leafy greens
- Broccoli and other cruciferous vegetables
- Bell peppers
- Tomatoes
- Beans and lentils
- Nuts and seeds
- Extra-virgin olive oil
- Herbs and spices
- Colorful fruits and vegetables
A Mediterranean-style eating pattern is particularly attractive because it supplies antioxidants, polyphenols, healthy fats, fiber, and numerous micronutrients without requiring high-dose antioxidant supplements.
This approach should be considered supportive rather than a proven treatment for TED.
9. Check Vitamin D Levels
Vitamin D deficiency is frequently studied in autoimmune thyroid disorders, including Graves' disease.
Low vitamin D levels have also been reported in some people with thyroid eye disease, but this does not establish that taking vitamin D will treat TED.
A sensible approach is to have a serum 25-hydroxyvitamin D level checked and correct a genuine deficiency rather than automatically taking very high doses.
For people who are deficient, restoring an adequate vitamin D level may support normal immune function and bone health, particularly if corticosteroids are eventually required.
Research Snapshot: Vitamin D deficiency is associated with several autoimmune thyroid conditions, but clinical evidence showing that vitamin D supplementation directly improves thyroid eye disease remains limited.
10. Reduce Excess Sodium if Eye Puffiness Is a Problem
A very salty meal can increase fluid retention in susceptible people.
Although reducing sodium does not treat the underlying autoimmune inflammation of thyroid eye disease, some people find that limiting highly salted and ultra-processed foods reduces morning facial and eyelid puffiness.
This is particularly worth experimenting with if swelling noticeably fluctuates according to diet.
Rather than pursuing an extremely low-sodium diet, focus first on reducing processed foods and excessive added salt.
11. Protect the Eyes From Wind and Bright Sun
TED can make the cornea unusually sensitive to sunlight, wind, dust, and dry air.
Large or wraparound sunglasses provide more protection than small lenses because they reduce airflow as well as ultraviolet exposure.
A humidifier may also help when indoor heating or air conditioning makes the air particularly dry.
These measures are simple, but reducing repeated irritation can make a significant difference in day-to-day comfort.
12. Stress Reduction and Restorative Sleep
Stress has complex effects on immune and inflammatory signaling, although there is no good evidence that stress reduction alone can stop thyroid eye disease.
Nevertheless, chronic stress and poor sleep can make pain, eye discomfort, fatigue, and the emotional impact of TED considerably harder to tolerate.
Useful practices may include meditation, gentle yoga, breathing exercises, walking, tai chi, and maintaining a regular sleep schedule.
These techniques are best regarded as supportive therapies for overall health and symptom management.
Natural Remedies That Need More Research
A number of supplements and natural compounds are sometimes proposed for thyroid eye disease because of their antioxidant or anti-inflammatory properties.
These include:
- Curcumin
- N-acetylcysteine (NAC)
- Alpha-lipoic acid
- Quercetin
- Resveratrol
- Other antioxidant combinations
Some of these compounds have intriguing laboratory research or broader evidence for anti-inflammatory effects.
However, that is not the same as demonstrating that they improve thyroid eye disease in humans.
At present, there is insufficient clinical evidence to recommend these supplements specifically for TED. This distinction is important because taking numerous antioxidants at high doses can introduce side effects and drug interactions without necessarily improving the disease.
What to Know: A supplement can have antioxidant or anti-inflammatory properties without having clinical evidence for thyroid eye disease. Selenium currently stands apart because it has been tested directly in people with mild Graves' orbitopathy.
A Special Warning About Radioactive Iodine
People with Graves' disease and thyroid eye disease should discuss radioactive iodine treatment carefully with their endocrinologist.
Radioactive iodine, commonly called RAI, can cause thyroid eye disease to develop or worsen in susceptible individuals, particularly smokers and people who already have active TED.
This does not mean RAI can never be used. In selected patients, doctors may prescribe corticosteroids around the time of treatment to reduce the risk of worsening eye disease.
Anyone with existing eye symptoms should make sure the physician treating the thyroid knows about them before choosing radioactive iodine treatment.
Important: If you already have thyroid eye disease or symptoms such as bulging, swelling, double vision, or eye pain, discuss those symptoms before undergoing radioactive iodine treatment.
When Natural Remedies Are Not Enough
Natural and conservative measures are most appropriate for mild thyroid eye disease.
Moderate-to-severe active TED may require medical treatment to control orbital inflammation. Depending on the individual case, treatment can include corticosteroids, targeted biologic medications such as teprotumumab, other immunomodulatory therapies, radiation therapy, or surgery.
Sight-threatening thyroid eye disease is an emergency.
Seek urgent ophthalmologic care for:
- New loss or dimming of vision
- Colors suddenly appearing dull or washed out
- Loss of part of the visual field
- Significant new double vision
- Severe or rapidly worsening eye pain
- Rapidly increasing eye protrusion
- Inability to close the eye adequately
- Significant corneal pain or damage
These symptoms can indicate compression of the optic nerve or dangerous exposure of the cornea and should not be treated at home.
Seek Immediate Medical Care: Reduced vision, faded color vision, rapidly worsening double vision, severe eye pain, or an inability to close the eyelids can indicate serious complications of thyroid eye disease.
The Bottom Line
For mild thyroid eye disease, the natural approach with the strongest scientific support is surprisingly straightforward.
Selenium has the best direct clinical evidence, particularly for mild, active disease in people with low or marginal selenium intake. Keeping thyroid levels stable and completely avoiding cigarette smoke are equally important strategies for reducing the risk of progression.
Cold compresses, preservative-free artificial tears, nighttime eye lubrication, head elevation, sunglasses, and a humidifier can help manage the dryness, irritation, swelling, and light sensitivity associated with TED.
An antioxidant-rich Mediterranean-style diet, adequate vitamin D, omega-3-rich foods, appropriate sleep, and stress reduction may provide additional general anti-inflammatory support, but these measures have not been proven to reverse thyroid eye disease.
Most importantly, TED should not be judged solely by how the eyes look or feel. Because inflammation behind the eye can occasionally threaten vision, anyone with significant or worsening symptoms should be evaluated by an ophthalmologist familiar with thyroid eye disease.
References
1. Marcocci C, et al. Selenium and the Course of Mild Graves' Orbitopathy. New England Journal of Medicine. 2011.
2. European Group on Graves' Orbitopathy (EUGOGO). Clinical Practice Guidelines for the Medical Management of Graves' Orbitopathy. European Journal of Endocrinology. 2021.
3. American Thyroid Association and European Thyroid Association. Management of Thyroid Eye Disease: A Consensus Statement. Thyroid. 2022.
4. American Thyroid Association. Thyroid Eye Disease (Graves' Ophthalmopathy/Graves' Orbitopathy).
