Can you develop thyroid-related eye disease even if you don’t have hyperthyroidism? Nearly 30% of patients do not have a history of hyperthyroidism. “My thyroid function is normal, so how can I develop thyroid-related eye disease? Isn’t this disease caused by ‘hyperthyroidism’?” At the beginning of the year, his family overheard that Mr. Lin’s left upper eyelid margin had shifted upward, causing his left eye to ‘show white’ and making it look like his left eye was bigger and his right eye smaller. However, there was no obvious discomfort in his eyes, so Mr. Lin didn’t pay much attention to it. A few months later, Mr. Lin’s left eye became more aggressive, with a prominent protrusion of the eyeball. In desperation, Mr. Lin came to Jiangsu Provincial People’s Hospital to seek help from an orbital disease specialist. After careful history taking and eye examination, the director diagnosed Mr. Lin with “thyroid-related ophthalmopathy”. The disease is a common orbital disease, and is the first in the adult group with about 20% incidence. Clinical manifestations include protruding eyeballs, receding eyelids, bulbar conjunctival edema, eye movement disorders, diplopia, and optic nerve compression. ”Among patients with thyroid-related ophthalmopathy, about 70% have a history of ‘hyperthyroidism’, 5% have ‘hypothyroidism’, and 25% have normal thyroid function for a significant period of time. ” The relationship between the time of onset of thyroid-related eye disease and “hyperthyroidism” can be divided into three cases: 35% of patients have thyroid-related eye disease followed by “hyperthyroidism”; 25% of patients have both; 25% have “hyperthyroidism” followed by “thyroid-related eye disease”. The relationship between “hyperthyroidism” and “hyperthyroidism” can be divided into three types of cases: 35% of cases have thyroid-related eye disease followed by “hyperthyroidism”; 25% of cases have both; and 40% of cases have “hyperthyroidism” followed by thyroid-related eye disease. “To put it simply, most patients with thyroid-related eye disease have a history of ‘hyperthyroidism’, but some patients with thyroid-related eye disease may not have ‘hyperthyroidism’ or may develop ‘hyperthyroidism’ in the future. ‘.” ”The gender of the disease is slightly unique, with those with combined ‘hyperthyroidism’ being more common in young and middle-aged women, and those with ocular symptoms alone without ‘thyroid’ abnormalities being more common in men.” Patients with purely ocular signs and normal or even low “A” function are mostly middle-aged and elderly males, mostly with monocular or bilateral onset of the disease, with mild disease in the early stage, light inflammatory response, atypical clinical symptoms, and mostly poor response to glucocorticoid therapy. In the middle and late stages, the disease is severe, the lesions continue to develop, and fibrotic lesions occur earlier in the extraocular muscles and other tissues. “The fibrosis of the extraocular muscles is like a bull’s-eye tendon that has lost its elasticity and cannot contract freely, so the patient’s eye movements are restricted, causing the patient to look at things out of sync, with symptoms such as diplopia and strabismus.” Patients with “hyperthyroidism” thyroid-related ophthalmopathy tend to be young and middle-aged women with bilateral onset of the disease and a pronounced inflammatory response in the eyes, but the fibrotic lesions in the orbital soft tissues are slow to develop, easy to remit and recurrent, and sensitive to glucocorticoid therapy.