Patients with hyperthyroidism combined with proptosis are often seen in outpatient clinics, either due to the lack of treatment experience of doctors or because they have fallen prey to some shady doctors and missed the best time for treatment, which seriously affects the quality of life of patients and some of them are at risk of blindness. Is hyperthyroidism combined with proptosis so difficult to treat? Proptosis is a common clinical manifestation of hyperthyroidism. About half of the patients with hyperthyroidism have proptosis, most of which are non-invasive proptosis, also known as benign proptosis, while a few have infiltrative proptosis, which is also known as malignant proptosis. According to clinical statistics, about 75-80% of patients with proptosis have hyperthyroidism, while about 20% have normal thyroid function, and less than 5% of patients with proptosis have hypothyroidism. What they have in common is that the occurrence of proptosis is related to thyroid disease, and the exact name should be thyroid-related ophthalmopathy. The pathogenesis of thyroid-associated ophthalmopathy is complicated by the production of antibodies by lymphocytes that are immune to their own tissues, causing some reaction in the periorbital tissues. In the early stage, the proliferation of cellular stroma and inflammatory reaction are the main causes, while in the late stage, the proliferation including fibroblasts and adipocytes is the main cause. At the stage of cellular hyperplasia, it is difficult to retract the proptosis with drug therapy. Non-infiltrative proptosis is mainly caused by sympathetic excitation of the extraocular muscles and the levator muscle during hyperthyroidism and is usually not associated with uncomfortable symptoms. Infiltrative proptosis is often combined with discomfort manifestations based on proptosis, most commonly eye swelling, pain, photophobia and tearing, foreign body sensation in the eye, and then in severe cases, inability to close the eye, loss of vision, and eventually blindness. Non-invasive proptosis usually improves after controlling hyperthyroidism, and no special treatment is needed for proptosis. Infiltrative proptosis, on the other hand, requires treatment. In other words, whenever there are symptoms of eye discomfort, it is important to go to the best endocrine specialist or thyroid treatment center as soon as possible for consultation and treatment by experienced doctors. The severity of the disease is evaluated according to the relevant guidelines established by international academic institutions for thyroid disorders and thyroid-related eye diseases, through a detailed history and necessary tests (including thyroid-related hormones, autoimmune status and, if necessary, orbital CT, MRI or ultrasound). The doctor will assess the level of control of hyperthyroidism, the degree and classification of proptosis, the combination of eyelid or conjunctival edema and congestion, the involvement of the extraocular muscles, the involvement of the optic nerve, and the presence of other systemic diseases before formulating an individualized treatment plan. Glucocorticoid therapy for hyperthyroidism is the treatment of choice for thyroid-related eye disease. Some patients have concerns about the use of glucocorticosteroids and delay in receiving regular treatment, thus losing the best time for early treatment. Therefore, we recommend that patients should visit a professional doctor as soon as they experience eye discomfort, eye swelling, pain, photophobia, tearing and protrusion of the eyeball. After individualized treatment, the doctor adjusts the treatment plan according to the patient’s response to treatment and observes the efficacy through close follow-up. The remission rate of newly developed proptosis is usually high with standardized treatment, and there is also an improvement rate in those with longer duration of disease. Other treatment options include radiotherapy of the posterior tissues of the eye and surgical treatment of orbital decompression usually when glucocorticoid therapy is not effective. Patients with thyroid-related eye disease should also be aware of smoking cessation. Patients who smoke have a 5-fold greater incidence of proptosis compared to nonsmokers and are also less sensitive to treatment, and smoking cessation can help improve the prognosis. It is also important to maintain normal thyroid function. It is recommended that patients with thyroid-related eye disease need frequent follow-up visits to the endocrinology department to effectively control and mitigate the occurrence of malignant proptosis on the basis of ensuring normal thyroid function.