Thyroid eye disease (TED), also known as Graves ophthalmopathy or thyroid-associated orbitopathy, is an autoimmune inflammatory disorder of the orbit characterized by enlargement of extraocular muscles, expansion of orbital fat, and secondary effects on the eyelids, ocular surface, and optic nerve. (1, 2) Although most commonly associated with Graves disease, TED may also occur in euthyroid or hypothyroid patients, including those with Hashimoto thyroiditis, demonstrating that the autoimmune mechanisms underlying orbital inflammation are distinct from thyroid hormone status alone. (1, 2)