Genetics: Even family members of patients with TED, who have never been diagnosed with any thyroid problems, have been noted to have early eyelid changes, including opening of the eyes (or eyelid retraction). A family history of TED can predispose you to having a more severe disease course.
Age/Sex: While TED is predominantly a disease of young women, a small but significant percentage of patients with TED are older. These patients also tend to be male. Older, male patients tend to have worsening eye symptoms.
Thyroid Hormone: Prolonged hypothyroidism (or low thyroid hormone levels) after treatment for Graves’ (either radioactive iodine, or pills, or surgical removal of the thyroid) can lead to worsening of the eye disease. A high antibody level also is predictive of a more severe disease course.
Smoking: Smoking is the absolutely worst thing that a patient with TED can do. Smoking is proven to worsen disease, and stopping smoking is proven to reverse disease. Smoking can even worsen TED to the point of vision loss!
Radioactive iodine treatment: Radioactive iodine (RAI) is also proven to worsen TED in patients. Treatment with steroid medicine at the same time as the RAI treatment is recommended to reduce this risk. Patients can also consider surgical removal of the thyroid.