Abadie’s Sign of Exophthalmic Goiter

Abadie’s sign of exophthalmic goiter is a special eye sign seen in people with Graves’ disease, which is a form of exophthalmic goiter (autoimmune hyperthyroidism). In this sign, the upper eyelid muscle (called the levator palpebrae superioris) goes into a small spasm and pulls the upper lid higher than normal. Because the lid is pulled up, the white part of the eye (the sclera) can be seen above the colored part of the eye (the cornea) even when the person looks straight ahead. This makes the eyes look wide, staring, and more “bulging” together with the forward protrusion of the eyeball that happens in Graves’ disease. Wikipedia+2Wikidoc+2

Abadie’s sign of exophthalmic goiter is a clinical sign, not a disease by itself. It means there is a spasm of the levator palpebrae superioris muscle, the small muscle that lifts the upper eyelid. Because of this spasm, the upper eyelid pulls up and you can see the white of the eye (sclera) above the colored part. This sign usually appears in people with Graves’ disease (also called exophthalmic goiter), where the thyroid is overactive and the eyes are pushed forwards (thyroid eye disease).Wikipedia+2Taber’s Medical Dictionary+2

In Graves’ disease, the immune system attacks the thyroid and tissues around the eyes. Extra thyroid hormone speeds up the body, and immune cells cause swelling of eye muscles and fat in the orbit. This combination leads to bulging eyes, lid retraction, lid lag, gritty eyes, and signs like Abadie’s sign. Treating the underlying thyroid problem and the eye inflammation is the real goal; the sign itself usually improves when the disease is controlled.Wikipedia+2EyeWiki+2

Abadie’s sign is named after Charles Abadie, a French ophthalmologist who described this eyelid spasm in people with exophthalmic goiter. It is one of several classic “eponymous signs” of thyroid eye disease, all related to changes in the eyelids and eye position due to the autoimmune process and the effect of excess thyroid hormone on the eye muscles and surrounding tissues. morancore.utah.edu+1

Other names of Abadie’s sign of exophthalmic goiter

Abadie’s sign itself does not have many alternative formal names, but it is often mentioned in the same group as other eyelid signs of Graves’ disease. In practice, some authors describe it in slightly different words, but they mean the same clinical finding: a spasm and retraction of the upper eyelid due to levator palpebrae superioris overactivity in thyroid eye disease. morancore.utah.edu+1

You may see it referred to or described as:

1. Abadie’s sign of exophthalmic goiter – the full classic name. Wikipedia+1

2. Abadie’s eyelid spasm sign – informal description used in some teaching texts and lecture notes to stress that it is a spasm of the upper eyelid muscle. IOSR Journals+1

3. Abadie’s upper eyelid retraction sign – another descriptive phrase sometimes used in lists of signs of thyroid ophthalmopathy to emphasize that the upper lid is drawn upward. Facebook+1

These phrases all point to the same clinical eye sign and are linked to exophthalmic goiter (Graves’ disease) rather than to other uses of the name “Abadie’s sign,” such as the different neurological sign in tabes dorsalis involving the Achilles tendon. PMC+1

Types and related forms of Abadie’s sign

There is really only one true “type” of Abadie’s sign of exophthalmic goiter: an upper lid spasm and retraction related to Graves’ thyroid eye disease. However, in clinical teaching, doctors often think about it in relation to other eyelid signs and to different severities and settings. For simple understanding, we can describe it in a “type-like” way: morancore.utah.edu+2Life in the Fast Lane • LITFL+2

1. Mild Abadie’s sign – the upper lid is only slightly higher than normal, and the sclera above the cornea is just a thin white line. The spasm may be subtle and seen only on careful examination, often in early or mild thyroid eye disease.

2. Moderate Abadie’s sign – the upper lid retraction is clear, the white of the eye is easily visible above the cornea, and the person has a noticeable “staring” look even in normal light.

3. Severe Abadie’s sign – the eyelid spasm and retraction are strong, the eyeball is pushed forward due to Graves’ orbitopathy, and the patient may have symptoms like pain, dryness, and exposure of the cornea. This often occurs with more advanced thyroid eye disease.

4. Abadie’s sign associated with other lid signs – in many patients, Abadie’s sign appears together with other eponymous signs, such as Dalrymple’s sign (lid retraction), von Graefe’s sign (lid lag on downward gaze), Stellwag’s sign (infrequent blinking), and Kocher’s sign (staring, frightened look on fixation). Wikipedia+2Life in the Fast Lane • LITFL+2

These “types” are not official separate diagnoses but are useful to show that Abadie’s sign can range from very mild to very severe and often lives inside the broader picture of Graves’ ophthalmopathy. NCBI+1

Causes of Abadie’s sign of exophthalmic goiter

In simple terms, Abadie’s sign occurs because of exophthalmic goiter, which is most commonly Graves’ disease. Anything that causes or worsens Graves’ disease or its eye involvement can be thought of as a “cause” or contributing factor for the sign. Wikipedia+2Allen+2

1. Autoimmune Graves’ disease – the main cause is an autoimmune attack on the thyroid, where antibodies stimulate the thyroid-stimulating hormone (TSH) receptor, leading to excessive thyroid hormone and eye tissue changes. This overactivity and immune reaction disturb the levator muscle and cause the eyelid spasm. NCBI+1

2. Genetic susceptibility – people with certain genetic backgrounds are more likely to develop Graves’ disease and thyroid eye signs, including Abadie’s sign. Family history of autoimmune thyroid disease increases the chance of this sign appearing. NCBI+1

3. Female sex and hormonal factors – Graves’ disease and thyroid eye disease are more common in women, especially in middle age, probably due to hormonal and immune system differences; this indirectly raises the risk of Abadie’s sign. NCBI+1

4. Cigarette smoking – smoking is one of the strongest modifiable risk factors for developing and worsening thyroid eye disease. Smokers with Graves’ disease have a higher risk of severe eye findings, including eyelid retraction and spasm. NCBI+1

5. High levels of thyroid hormone (thyrotoxicosis) – excess T3 and T4 increase sympathetic nervous system activity, making muscles like the levator palpebrae more excitable and prone to spasm, which helps create Abadie’s sign. NCBI+1

6. Thyroid-stimulating antibodies (TSI/TRAb) – these antibodies not only act on the thyroid but also act on tissues around the eyes, including fibroblasts and muscles. Their action leads to inflammation and remodeling that favor lid retraction. NCBI+1

7. Orbital fibroblast activation – in Graves’ orbitopathy, cells in the eye socket (fibroblasts) become activated, produce glycosaminoglycans, and attract water, causing swelling that alters the position and function of the extraocular muscles and lids. NCBI+1

8. Thickening of extraocular muscles – the muscles that move the eye become enlarged and stiff due to inflammation. This changes eyelid mechanics and can contribute to abnormal lid position and spasm. NCBI+1

9. Increased sympathetic tone to the eyelids – hyperthyroidism increases sympathetic output, which stimulates the Müller’s muscle and the levator muscle, making the upper eyelid sit higher and more prone to spasm. ScienceDirect+1

10. Chronic inflammation in the orbit – ongoing inflammation around the eyes leads to fibrosis and scarring. This can “fix” the eyelid in a retracted position and exaggerate the spasm that is seen in Abadie’s sign. NCBI+1

11. Poorly controlled hyperthyroidism – if thyroid hormone levels stay high or unstable, eye signs like lid retraction and Abadie’s sign are more likely to appear or worsen over time. NCBI+1

12. Radioiodine treatment without eye protection – in some patients, radioactive iodine to treat hyperthyroidism can temporarily worsen eye disease if glucocorticoid cover is not used, and this may make eyelid signs like Abadie’s sign more obvious. NCBI

13. Rapid correction of hypothyroidism after radioiodine or surgery – sudden shifts back to normal or low thyroid hormone levels can sometimes flare autoimmune activity in the orbit and bring out eye signs. NCBI+1

14. Pregnancy and postpartum immune changes – pregnancy and the period after delivery can alter immune balance and trigger or worsen Graves’ disease, leading to more eye findings including Abadie’s sign. BYJU’S+1

15. Coexisting autoimmune diseases – other autoimmune disorders, such as type 1 diabetes or rheumatoid arthritis, signal a sensitive immune system and can be associated with higher risk of Graves’ disease and its eye manifestations. NCBI+1

16. Iodine excess or deficiency in susceptible people – very high or very low iodine intake can trigger thyroid dysfunction in people with underlying autoimmune risk, indirectly contributing to development of exophthalmic goiter and eyelid signs. NCBI+1

17. Psychological and physical stress – strong or chronic stress may trigger autoimmune thyroid disease in genetically prone individuals, which can then lead to Abadie’s sign as the eye becomes involved. BYJU’S+1

18. Orbital venous congestion from thyroid disease – changes in blood flow and congestion around the eye in Graves’ orbitopathy may worsen proptosis and eyelid retraction, making Abadie’s sign more visible. NCBI+1

19. Delayed or absent treatment of Graves’ disease – not treating or delaying treatment allows thyroid hormone excess and orbital inflammation to progress, increasing the chance of seeing Abadie’s sign. NCBI+1

20. Recurrent Graves’ disease after previous control – when Graves’ disease comes back, eye signs can reappear or worsen, and Abadie’s sign may again become noticeable in the course of the relapse. NCBI+1

Symptoms and clinical features associated with Abadie’s sign

Abadie’s sign itself is a sign that the doctor sees, not a symptom that the patient feels. However, it appears in people who usually have many eye and body symptoms due to exophthalmic goiter (Graves’ disease). NCBI+1

1. Staring or frightened appearance – patients often feel that others say they “look scared” or “wide-eyed.” The retracted lid and protruding eye give a staring face expression that may be socially distressing. Wikipedia+1

2. Eye fullness or pressure sensation – many people feel a sense of pressure or fullness behind the eyes, as if the eye is being pushed forward, which comes from swollen orbital tissues. NCBI+1

3. Eye dryness and gritty feeling – because the eyelids do not close completely and the eyes are more exposed, the tear film dries quickly and patients often complain of dryness, burning, or a feeling of sand in the eyes. NCBI+1

4. Tearing and redness – paradoxically, dry eyes may produce reflex tearing, and the surface of the eye can become red and irritated, which is often noticed along with lid retraction. NCBI+1

5. Sensitivity to light (photophobia) – the wide palpebral opening and corneal exposure make the eyes more sensitive to bright light, so patients may squint or avoid sunlight. NCBI+1

6. Foreign body sensation and discomfort – patients can feel as if there is something stuck in the eye all the time, linked to dryness, corneal micro-damage, and eyelid malposition. NCBI+1

7. Blurred vision – dryness, corneal changes, and pressure on the optic nerve can lead to episodes of blurred vision, especially when the disease is more active or severe. NCBI+1

8. Double vision (diplopia) – thickened and stiff eye muscles can no longer move freely, so the two eyes do not line up correctly, and the patient can see two images, especially on looking up or sideways. NCBI+1

9. Eye pain or aching behind the eye – inflammation and pressure in the orbit can cause dull pain, which may worsen when the person looks up, down, or sideways. NCBI+1

10. Difficulty closing the eyes (lagophthalmos) – because the upper lid is pulled up, the eyelids may not meet fully during sleep or blinking, which makes exposure symptoms worse. Wikipedia+1

11. Headache around the eyes – strain from double vision, dry eyes, and inflammation can lead to headaches centered around the forehead or orbital region. NCBI+1

12. Systemic weight loss despite good appetite – as part of hyperthyroidism, people lose weight even though they eat more, which is often reported together with eye complaints. Cleveland Clinic+1

13. Palpitations and fast heartbeat – excess thyroid hormones make the heart beat faster and harder, so patients feel pounding or racing in the chest. This is an important associated systemic symptom. Cleveland Clinic+1

14. Heat intolerance and sweating – people may feel too hot, prefer cool environments, and sweat more than usual, which signals thyroid overactivity, the root problem behind Abadie’s sign. Cleveland Clinic+1

15. Anxiety, irritability, and tremor – overactive thyroid function makes the nervous system over-stimulated, so patients often feel anxious, shaky, and restless, which commonly co-exists with the eye signs. Cleveland Clinic+1

Diagnostic tests for Abadie’s sign of exophthalmic goiter

Abadie’s sign itself is diagnosed by clinical examination of the eyes. However, doctors use many tests to confirm the underlying exophthalmic goiter (Graves’ disease), to measure the effect on the eyes, and to rule out other causes of eye protrusion or eyelid problems. NCBI+2EyeWiki+2

Physical examination tests (about the eyes and thyroid)

1. Observation of eyelid position and stare – the doctor asks the patient to look straight ahead and observes whether the upper lid is abnormally high and whether the sclera is visible above the cornea. A high, spastic upper lid with visible sclera is typical of Abadie’s sign. Wikipedia+1

2. Assessment of blinking and lid closure – the doctor watches how often and how completely the patient blinks. Infrequent blinking (Stellwag’s sign) and incomplete closure with exposed cornea suggest thyroid eye disease and support the presence of Abadie’s sign. Wikipedia+1

3. Gaze tests for lid lag and other signs – the patient is asked to follow a finger moving up and down. Lid lag on downward gaze (von Graefe’s sign) and jerky lid movement (Boston’s sign) are often seen together with Abadie’s sign and confirm the thyroid origin of eyelid changes. Wikipedia+2IOSR Journals+2

4. Inspection of eye redness, chemosis, and corneal surface – the doctor looks at the conjunctiva and cornea with a light. Redness, swelling, and surface dryness show that lid retraction and eye exposure are causing ocular surface disease. NCBI+1

5. Thyroid gland palpation in the neck – the thyroid is felt in the neck to check for enlargement, nodules, or tenderness. A diffuse, smooth, non-tender enlargement strongly suggests Graves’ disease as the source of Abadie’s sign. NCBI+1

6. Vital signs and systemic examination – pulse rate, blood pressure, weight, tremor, and reflexes are checked for signs of hyperthyroidism. These systemic findings reinforce the link between eyelid signs and endocrine disease. NCBI+1

Manual tests and bedside measurements

7. Hertel exophthalmometry – this is a simple manual instrument that measures how far forward each eyeball is relative to the bony orbit. Higher values indicate exophthalmos and help quantify the severity of Graves’ orbitopathy associated with Abadie’s sign. EyeWiki+1

8. Manual lid retraction and resistance test – the examiner gently pulls down or pushes up the eyelids to feel how tight or resistant they are. Increased resistance and spastic feel of the upper lid support the diagnosis of Abadie’s sign. IOSR Journals+1

9. Ocular motility testing with a pen light – the doctor moves a pen or finger in different directions and checks how well each eye follows. Restricted eye movements suggest muscle involvement of thyroid eye disease, which often occurs together with eyelid signs. NCBI+1

10. Visual acuity and visual field testing at the bedside – basic tests of central vision and side vision help to check if optic nerve compression from severe orbitopathy is occurring, which is important in advanced cases with strong lid and eye signs. NCBI+1

Laboratory and pathological tests

11. Serum TSH (thyroid-stimulating hormone) – this is usually very low in Graves’ disease because the pituitary gland reduces TSH release in response to high thyroid hormone levels. A low TSH supports the diagnosis behind Abadie’s sign. NCBI+1

12. Free T4 and free T3 levels – these are usually high in uncontrolled Graves’ disease and show the degree of thyroid hormone excess, which drives many of the eye and eyelid changes. NCBI+1

13. TSH receptor antibody (TRAb) or thyroid-stimulating immunoglobulin (TSI) – these antibodies are often positive in Graves’ disease and directly reflect the autoimmune cause. A positive TRAb or TSI test helps confirm that Abadie’s sign is related to Graves’ disease rather than another condition. NCBI+1

14. Anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin antibodies – these antibodies show general autoimmune activity against the thyroid and are often present in Graves’ disease, giving more evidence of autoimmune thyroid origin. NCBI+1

15. Basic blood tests (CBC, ESR, CRP) – these tests help to look for other systemic inflammation or anemia and to rule out infection or other systemic illnesses that might affect the eye. They are supportive rather than specific. NCBI+1

16. Lipid profile and glucose tests – these are checked because hyperthyroidism and its treatment may influence metabolism, and coexisting metabolic problems can affect overall management of the patient with Abadie’s sign. NCBI+1

17. Fine-needle aspiration cytology (FNAC) of thyroid nodule, if present – if a nodule is found in the thyroid, FNAC may be done to rule out other thyroid diseases or cancer, making sure the eye signs truly come from Graves’ disease and not another thyroid problem. NCBI

Electrodiagnostic tests

18. Visual evoked potential (VEP) – this test measures the electrical response of the brain to visual stimuli. It can be used when there is concern about optic nerve compression from severe Graves’ orbitopathy, which may occur in patients with marked lid and eye signs like Abadie’s sign. NCBI+1

19. Electromyography (EMG) of extraocular or eyelid muscles (rarely used) – in complex or research settings, EMG may be used to study muscle activity in the levator palpebrae superioris or extraocular muscles. Increased activity or abnormal patterns would support a neuromuscular basis for the lid spasm. PubMed+1

Imaging tests

20. Orbital CT scan – CT imaging of the orbits shows enlargement of the extraocular muscles, increased fat, and crowding at the orbital apex. These findings are typical of Graves’ orbitopathy and confirm that the mechanical environment of the eyelids and eyes is changed, explaining Abadie’s sign. NCBI+1

21. Orbital MRI – MRI gives detailed images of soft tissues, muscles, and the optic nerve. It is useful in active disease and in planning surgery, further supporting the diagnosis when Abadie’s sign and other eyelid signs are present. NCBI+1

22. Thyroid ultrasound – ultrasound of the thyroid gland shows a diffusely enlarged and hyper-vascular gland typical of Graves’ disease. This helps connect the eye findings with a clear thyroid source. NCBI+1

23. Radioiodine uptake scan – this nuclear medicine test measures how much iodine the thyroid absorbs. High, diffuse uptake supports Graves’ disease rather than other causes of hyperthyroidism and indirectly backs the link to Abadie’s sign. NCBI+1

Together, these physical, manual, laboratory, electrodiagnostic, and imaging tests allow doctors to confidently recognize Abadie’s sign of exophthalmic goiter, understand how active and severe the thyroid eye disease is, and plan safe and effective treatment of both the thyroid gland and the eyes. NCBI+2Wikipedia+2

Non-pharmacological treatments

These non-drug treatments aim to reduce eye discomfort, protect the cornea, and support overall control of Graves’ disease and thyroid eye disease (TED), which will also help Abadie’s sign.EyeWiki+1

1. Stopping smoking
   Smoking is the strongest lifestyle risk factor for thyroid eye disease. Stopping cigarettes lowers inflammation around the eyes and can reduce the risk that mild disease will become severe. Eye and endocrine guidelines clearly advise every patient with Graves’ disease or TED to quit smoking as early as possible.EyeWiki+1

2. Artificial tears and eye lubricating gels
   Non-preserved artificial tears during the day and thicker gels at night keep the eye surface moist. This protects the cornea from drying when the eyelids do not close fully because of lid retraction and exophthalmos. Regular lubrication can reduce burning, redness, and feeling of sand in the eyes.EyeWiki

3. Cool compresses
   Cool, not icy, compresses placed gently over closed eyes for short periods can temporarily reduce redness, swelling, and discomfort. The cold constricts blood vessels and slightly calms the overactive tissues around the eye. This is a simple home measure that can be repeated a few times per day in active TED.EyeWiki+1

4. Head elevation during sleep
   Sleeping with the head raised on extra pillows or a wedge helps fluid drain from the eye region overnight. This can reduce morning eyelid swelling and pressure sensation. It is a low-risk measure often recommended as part of basic thyroid eye disease self-care.EyeWiki

5. Prism glasses and optical aids
   If eye muscle inflammation causes double vision, temporary stick-on prisms or special lenses can help realign images so that the person can see single again. These optical aids do not cure the muscle problem, but make daily life safer and more comfortable while the disease is still changing.EyeWiki+1

6. Protective sunglasses and moisture chambers
   Wrap-around sunglasses or glasses with side shields protect from wind, dust, and bright light, which often worsen eye discomfort in TED. Some people use “moisture chamber” glasses that hold humidity near the eye and reduce dryness caused by incomplete blinking and lid retraction.EyeWiki+1

7. Taping eyelids closed at night (short-term)
   If the eyelids cannot close completely during sleep, gentle medical tape can sometimes be used to keep them closed at night, under guidance from an eye doctor. This helps protect the cornea from exposure and ulcers until more permanent treatment is given.EyeWiki

8. Eye-patching for severe exposure or double vision
   Temporary patching of one eye may be used in cases of severe double vision or corneal exposure. It reduces visual confusion and gives the cornea time to heal when combined with lubrication. This is usually a short-term strategy until the underlying disease is better controlled.EyeWiki+1

9. Systematic stress management
   Stress does not cause Graves’ disease alone, but it can worsen autoimmune activity and symptoms such as palpitations and anxiety. Relaxation techniques, breathing exercises, meditation, and regular counseling can help patients cope better and may indirectly support immune balance and sleep quality.NCBI+1

10. Adequate sleep and sleep hygiene
    Good sleep supports the immune system and hormone balance. Fixed bedtimes, a dark, quiet room, and limiting screens before bed can help. For TED, better sleep also reduces daytime fatigue and sensitivity to light and can make eye discomfort easier to tolerate.NCBI+1

11. Balanced iodine intake
    Very high iodine intake (from supplements or contrast media) can worsen hyperthyroidism in Graves’ disease, while iodine deficiency can also stress the thyroid. A normal, food-based iodine intake is usually recommended, and unnecessary iodine supplements are avoided unless a doctor advises them.NCBI+1

12. Regular aerobic exercise within limits
    Moderate exercise like walking, cycling, or swimming helps mood, heart health, and weight control in hyperthyroid patients once heart rate is controlled. It should be started only after a doctor confirms that heart rhythm and blood pressure are safe.NCBI+1

13. Eye-muscle and eyelid relaxation exercises
    Gentle blinking exercises and planned breaks during reading or screen work can help reduce eye strain. Though they do not correct muscle inflammation, they can ease discomfort and dryness linked to reduced blinking in TED and Abadie’s sign.EyeWiki

14. Environmental adjustments (humidity and lighting)
    Humidifiers, avoiding direct air-conditioner flow, and using softer room lighting reduce eye irritation. Simple environmental changes are often recommended before stepping up to stronger medical treatments.EyeWiki+1

15. Weight and blood sugar management
    Graves’ disease and steroid treatments used for TED can affect weight and blood sugar. Nutrition counseling and regular monitoring help lower cardiovascular risk and may improve overall treatment results and safety.NCBI+1

16. Avoiding irritant cosmetics and contact lenses in active disease
    During active TED with lid retraction and corneal exposure, eye make-up and contact lenses can make dryness and scratches worse. Doctors often suggest avoiding them until the surface is stable.EyeWiki

17. Careful control of thyroid function (with doctor)
    Even though medicines or radioiodine may be involved, the non-pharmacological part is regular follow-up and lab testing. Keeping thyroid hormone levels in the target range is essential to reduce eye inflammation and signs like Abadie’s sign over time.NCBI+1

18. Psychological support and patient groups
    Chronic changes in appearance, like bulging eyes and lid retraction, can strongly affect self-esteem and mental health. Counseling and support groups help patients cope with body-image changes and anxiety related to Graves’ disease and TED.EyeWiki+1

19. Sun protection and UV-blocking lenses
    UV-blocking sunglasses protect the eye surface and skin around the eyes. This lowers irritation and protects against extra light sensitivity that is common in exophthalmic goiter and eyelid retraction.EyeWiki

20. Close interdisciplinary follow-up
    Regular appointments with an endocrinologist and ophthalmologist are a key “therapy” by themselves. Team care allows early detection of vision-threatening complications and adjustment of treatment stages, from conservative measures up to surgery when needed.EyeWiki+1

---

Drug treatments

Drug treatment is aimed at controlling thyroid hormone levels, calming the heart, and reducing inflammation in the orbit so that signs like Abadie’s sign improve. Only a specialist can choose the right drug or dose for a specific patient.NCBI+2Wikipedia+2

1. Methimazole (Tapazole® and generics)
   Methimazole is the main antithyroid drug used to reduce thyroid hormone production in Graves’ disease. Tablets are usually taken once or several times daily, with total daily doses often starting around 10–40 mg depending on severity, then reduced for maintenance, according to FDA labeling. Side effects can include rash, liver problems, and rare severe low white cells, so regular blood tests are essential.FDA Access Data+2FDA Access Data+2

2. Propylthiouracil (PTU)
   Propylthiouracil also blocks thyroid hormone production and partially blocks conversion of T4 to T3. It is mainly reserved for patients who cannot take methimazole or for early pregnancy because of liver toxicity risk. Doses are usually divided through the day (for example 100–150 mg three times daily at the start) and then lowered as levels improve.FDA Access Data+2FDA Access Data+2

3. Carbimazole (where available)
   Carbimazole is converted to methimazole in the body and is widely used outside the United States as an antithyroid drug. It is given in divided doses and then tapered. Side effects and monitoring needs are similar to methimazole, including the rare but serious risk of agranulocytosis, so fever or sore throat must be checked urgently.NCBI+1

4. Teprotumumab-trbw (TEPEZZA®)
   Teprotumumab is a monoclonal antibody that targets the IGF-1 receptor on orbital fibroblasts. It is given as intravenous infusions: 10 mg/kg for the first dose, then 20 mg/kg every three weeks for seven more doses, in approved labeling for thyroid eye disease. It can significantly reduce proptosis and eye muscle swelling but may cause side effects like hearing changes and high blood sugar.FDA Access Data+2FDA Access Data+2

5. Systemic glucocorticoids (e.g., prednisone)
   Oral or intravenous steroids reduce inflammation in the orbit in active TED. Prednisone or prednisolone is often started at a moderate to high dose and then slowly tapered over weeks, based on specialist protocols. Long-term steroids can cause weight gain, mood changes, osteoporosis, infection risk, and blood sugar problems, so they require close monitoring.FDA Access Data+2FDA Access Data+2

6. Pulse intravenous methylprednisolone
   In more severe active eye disease, high-dose methylprednisolone pulses are sometimes given intravenously once weekly or on special schedules. This can produce a stronger and faster anti-inflammatory effect than oral steroids but carries risks to the liver and heart, so strict dose limits and monitoring are followed.PMC+1

7. Propranolol
   Propranolol is a non-selective beta-blocker that slows heart rate and reduces tremor and anxiety symptoms of hyperthyroidism. Typical oral doses for hyperthyroid symptoms may range from about 10–40 mg several times daily, adjusted for pulse and blood pressure. It does not treat the cause of Graves’ disease but improves comfort while antithyroid therapy is working.FDA Access Data+2FDA Access Data+2

8. Atenolol
   Atenolol is a beta1-selective blocker used as an alternative when propranolol is not suitable. Once-daily dosing (for example 25–100 mg) can control heart rate in some patients. Like other beta-blockers, it must be used carefully in asthma, severe low heart rate, or certain types of heart block.FDA Access Data+2FDA Access Data+2

9. Metoprolol (and other beta-blockers)
   Metoprolol is another cardio-selective beta-blocker used similarly to atenolol to decrease palpitations and tremor. It is typically given once or twice daily in doses adjusted to symptom relief and heart rate. These drugs are usually used short-term until the thyroid is controlled.NCBI+1

10. Levothyroxine (thyroid hormone replacement)
    After radioiodine therapy or thyroid surgery, many patients become hypothyroid and need levothyroxine replacement. Tablets are usually taken once daily on an empty stomach, with typical doses around 1.6 micrograms per kilogram per day and adjusted by TSH levels. Proper dosing helps maintain stable thyroid function and may prevent new eye flares.FDA Access Data+2FDA Access Data+2

11. Selenium (as a prescribed supplement in specific cases)
    Selenium is not a classic “drug,” but controlled trials show that 100 µg twice daily for six months can improve mild active Graves’ orbitopathy in selenium-deficient regions. It works as an antioxidant and may reduce disease activity and slow progression when combined with standard care.New England Journal of Medicine+2Frontiers+2

12. Lubricating eye drops with hyaluronic acid
    Medical eye drops with hyaluronic acid or similar agents are used regularly in TED to protect the surface. They are applied several times per day as needed and have minimal systemic side effects, making them a safe long-term support for Abadie’s sign–related exposure.EyeWiki+1

13. Topical eye gels and ointments
    Thicker gels or ointments used at bedtime provide longer moisture for partially open eyes. They may blur vision temporarily but greatly lower the risk of corneal damage. These are usually combined with taping or moisture shields at night.EyeWiki+1

14. Immunosuppressants (e.g., mycophenolate mofetil)
    In selected severe or steroid-resistant cases, drugs like mycophenolate may be used to reduce immune activity driving TED. They are taken orally and require careful blood tests for bone-marrow, liver, and infection risks. These treatments are highly specialized and are only used under expert supervision.PMC+1

15. Rituximab
    Rituximab is a monoclonal antibody that depletes B-cells. Some studies have explored its use in active TED, but evidence is mixed, and it is not first-line. It is given by infusion in hospital and carries risks like infusion reactions and infection, so it is reserved for selected severe cases.PMC+1

16. Cyclosporine or azathioprine (adjunctive use)
    These oral immunosuppressants are sometimes used together with steroids in difficult thyroid eye disease. They aim to reduce steroid dose and maintain control of inflammation. Monitoring includes kidney function, liver tests, and blood pressure, as side effects can be serious.PMC+1

17. Short-term anxiolytics (e.g., for severe anxiety)
    In some patients, severe anxiety from hyperthyroidism and eye changes may be treated briefly with medicines like benzodiazepines, always carefully monitored and time-limited because of dependence risk. Psychological therapies are preferred for long-term management.NCBI+1

18. Proton pump inhibitors (PPIs) when on high-dose steroids
    PPIs like omeprazole are often given alongside high-dose steroids to protect the stomach from ulcers. They have their own side effects, so the dose and duration are kept to the shortest needed period.PMC+1

19. Calcium and vitamin D with steroid therapy
    Steroids can thin the bones, so calcium and vitamin D are often added to protect bone health. Doses are adjusted according to diet, age, and lab tests, and they are usually used along with weight-bearing exercise and sometimes other osteoporosis medicines.PMC+1

20. Medicines for associated conditions (e.g., blood pressure, diabetes)
    Because Graves’ disease and its treatment can affect the heart and metabolism, some patients need additional drugs for high blood pressure, rapid heart rhythm, or steroid-induced diabetes. These medicines do not directly treat Abadie’s sign but are vital for safe overall management.NCBI+1

---

Dietary molecular supplements

Supplements must never replace proper medical treatment for Graves’ disease or thyroid eye disease, but some nutrients may support antioxidant defenses and general health. Always ask a doctor before taking any supplement.Frontiers+1

1. Selenium
   Selenium is a trace element that supports antioxidant enzymes like glutathione peroxidase. Clinical trials show that about 200 µg/day for six months can reduce activity scores and improve quality of life in mild Graves’ orbitopathy, especially in regions with low selenium intake. Over-supplementation can be toxic, so doses must stay within medical advice.New England Journal of Medicine+2Frontiers+2

2. Vitamin D
   Vitamin D modulates the immune system and bone health, which is important when steroids are used. Correcting deficiency, often with 800–2000 IU/day or more under guidance, may support immune balance and reduce osteoporosis risk. Too much vitamin D can cause high calcium, so blood levels must be checked.Frontiers+1

3. Omega-3 fatty acids (fish oil)
   Omega-3 fats from fish oil capsules may have mild anti-inflammatory effects. Regular doses used for general health (often around 1 g/day of EPA+DHA) may support heart health and possibly eye surface comfort, although evidence in Graves’ eye disease is limited. They can increase bleeding risk at high doses.Frontiers+1

4. Vitamin C
   Vitamin C is a water-soluble antioxidant that helps protect tissues from oxidative stress. Normal dietary intake from fruits and vegetables is usually enough; sometimes 500–1000 mg/day is used for short periods. Very high doses may cause stomach upset or kidney stone risk in susceptible people.Frontiers+1

5. Vitamin E
   Vitamin E is a fat-soluble antioxidant that works in cell membranes. Moderate supplement doses may help overall antioxidant status, but high doses can increase bleeding risk and interact with blood thinners. It should only be used within safe daily limits and with medical advice.Frontiers+1

6. Zinc
   Zinc is important for immune function and tissue repair. Mild deficiency can weaken immunity and healing. Supplement doses are usually in the 10–25 mg/day range; long-term high intake can cause copper deficiency and other problems, so balance is important.Frontiers

7. B-complex vitamins
   B vitamins support energy metabolism and nerve function, which can feel disturbed in hyperthyroidism. Standard B-complex supplements provide moderate doses and are generally safe, but “megadose” products are not recommended without supervision.Frontiers+1

8. Magnesium
   Magnesium is involved in muscle relaxation and nerve signaling. Adequate intake may ease muscle twitching or cramps and support heart rhythm, especially in hyperthyroid states, but evidence in TED is indirect. Doses must be adjusted in kidney disease.Frontiers+1

9. Coenzyme Q10
   CoQ10 participates in mitochondrial energy production and acts as an antioxidant. Some people use 100–200 mg/day hoping to improve fatigue and oxidative stress, though specific data in Graves’ disease are limited. It can interact with blood thinners, so medical advice is needed.Frontiers

10. L-carnitine
    L-carnitine helps transport fatty acids into mitochondria. Some studies suggest it may reduce symptoms of hyperthyroidism by affecting thyroid hormone action at the tissue level, but it is not a standard treatment. Typical doses in studies range around 2–4 g/day under supervision.Frontiers+1

---

Immunity-modulating and regenerative approaches

There are no approved stem cell drugs specifically for Abadie’s sign, Graves’ disease, or thyroid eye disease. Some treatments below are standard immunomodulatory drugs; others are experimental ideas used only in research.PMC+1

1. Teprotumumab as targeted immune modulation
   Teprotumumab blocks the IGF-1 receptor on orbital cells, reducing inflammation and tissue expansion. It is an example of targeted biologic therapy that changes a specific immune pathway rather than broadly suppressing the entire immune system. Infusions are given every three weeks for eight doses, and long-term safety is still under study.FDA Access Data+2FDA Access Data+2

2. Rituximab (B-cell depletion)
   Rituximab removes B-cells that produce antibodies, including those against the TSH receptor. It has been tried in active TED, with mixed results. It is given through intravenous infusions and can cause infusion reactions and infection risk, so it is reserved for very selected cases in expert centers.PMC+1

3. Mycophenolate mofetil (T- and B-cell modulation)
   Mycophenolate affects lymphocyte proliferation and can be combined with steroids for active eye disease. It may allow lower steroid doses, but requires close lab monitoring for blood-count, liver, and infection problems. It is not a cure, but part of a long-term immune-control plan.PMC+1

4. Cyclosporine and similar calcineurin inhibitors
   These drugs block T-cell activation by inhibiting calcineurin. In some cases of difficult TED, they are used together with steroids. Kidney function and blood pressure must be checked regularly because these medicines can be toxic if doses are too high.PMC+1

5. Experimental stem cell transplantation for autoimmune disease
   For some very severe, life-threatening autoimmune diseases, high-dose chemotherapy with autologous hematopoietic stem cell transplant has been studied. This is not standard for Graves’ disease or TED and carries serious risks like infection, infertility, and even death. Any use is strictly within clinical trials.Frontiers

6. General immune support (vaccination and infection control)
   Keeping up-to-date with routine vaccines and treating infections promptly helps avoid immune flare-ups and is especially important when patients are on steroids or other immunosuppressants. This is a simple but powerful part of “immune care” in chronic autoimmune thyroid disease.PMC+1

---

Surgeries

Surgery does not treat Abadie’s sign directly, but it can reduce exophthalmos, protect vision, and adjust the eyelids, which often improves the sign.EyeWiki+1

1. Radioiodine ablation of the thyroid
   Radioiodine is swallowed as a capsule or liquid. The thyroid cells take it up, and the radiation slowly destroys them. This is used to permanently treat hyperthyroidism in Graves’ disease. Afterward, most patients need lifelong levothyroxine, and careful monitoring is needed because radioiodine can sometimes worsen eye disease in active smokers.Wikipedia+1

2. Total or near-total thyroidectomy
   In this surgery, most or all of the thyroid gland is removed. It is chosen when radioiodine is not suitable, when a very large goiter is present, or when rapid control is needed. Thyroidectomy can help stabilize disease and may be preferred in some patients with severe orbitopathy, but it carries risks like bleeding, voice-nerve injury, and low calcium.NCBI+1

3. Orbital decompression surgery
   In orbital decompression, bone and sometimes fat from the orbit are removed to make more room for the swollen tissues. This lets the eyes sit farther back and reduces pressure on the optic nerve. It is done for sight-threatening compressive optic neuropathy or disfiguring proptosis after inflammation has settled.EyeWiki+1

4. Strabismus (eye-muscle) surgery
   If scarring of eye muscles leads to persistent double vision when the disease is stable, surgery can reposition or adjust the muscles. The goal is to gain comfortable single vision in straight-ahead and reading positions. It is usually done after decompression if both are needed.EyeWiki+1

5. Eyelid retraction surgery
   For lasting lid retraction and exposure, procedures can lengthen the eyelid or adjust the levator muscle. This can improve eye closure, protect the cornea, and reduce the obvious “staring” appearance linked to Abadie’s sign. Surgery is usually delayed until thyroid function and eye inflammation are stable.EyeWiki+1

---

Preventions

1. Do not smoke and avoid second-hand smoke.EyeWiki+1

2. Get early diagnosis and regular treatment for any thyroid imbalance.NCBI+1

3. Keep thyroid hormone levels within target range with the help of your doctor.NCBI+1

4. Protect eyes from dryness with regular artificial tears when symptoms begin.EyeWiki

5. Use sunglasses and avoid dusty, smoky environments to reduce irritation.EyeWiki

6. Maintain a balanced diet with enough selenium and other micronutrients but avoid unneeded megadoses.Frontiers+1

7. Avoid sudden, unsupervised changes in thyroid medicines or supplements.NCBI+1

8. Manage stress with healthy coping methods and seek support for anxiety or depression.NCBI+1

9. Keep blood pressure, blood sugar, and cholesterol in healthy ranges, especially when on steroids.PMC+1

10. Attend regular check-ups with both an endocrinologist and an eye specialist, even if symptoms feel mild.EyeWiki+1

---

When to see doctors

Anyone with signs of exophthalmic goiter or Abadie’s sign should see a doctor as soon as possible, even if they feel otherwise well. Sudden eye changes like new lid retraction, bulging eyes, or visible white above the iris can be early signs of thyroid eye disease. An endocrinologist can arrange thyroid tests and start treatment, and an ophthalmologist can check for corneal damage or pressure on the optic nerve.EyeWiki+1

Emergency care is needed immediately if there is eye pain, sudden drop in vision, blurred or double vision that appears quickly, color vision problems, or difficulty moving the eyes. These can be signs of compressive optic neuropathy, a sight-threatening complication of thyroid eye disease, and may require urgent steroids or orbital decompression surgery.EyeWiki+1

People who already have Graves’ disease should seek medical review if symptoms like racing heart, weight loss, heat intolerance, or tremor return, or if they feel very tired, cold, or gain weight suddenly, which may show under- or over-treatment. Regular follow-up helps keep thyroid levels stable and reduces the risk of eye flares and worsening of Abadie’s sign.NCBI+1

---

What to eat and what to avoid

1. Eat: A balanced diet rich in fruits, vegetables, whole grains, and lean protein supports overall healing and immune health.Frontiers+1

2. Eat: Foods that naturally contain selenium (such as Brazil nuts in very small amounts, seafood, eggs, and whole grains), within safe daily limits, may support thyroid and eye health.Frontiers+1

3. Eat: Calcium-rich foods like low-fat dairy and leafy greens, especially if you are taking steroids, to protect bone health.PMC+1

4. Eat: Adequate protein from fish, poultry, beans, or tofu to support muscle and tissue repair during chronic illness.Frontiers+1

5. Avoid: Very high iodine foods or supplements (such as large amounts of kelp or iodinated salt pills) unless specifically prescribed, because they can worsen hyperthyroidism in some people with Graves’ disease.NCBI+1

6. Avoid: Excess caffeine and energy drinks, which can worsen palpitations, tremor, and anxiety symptoms of hyperthyroidism.NCBI+1

7. Avoid: Heavy alcohol intake, which increases liver stress and may interact badly with antithyroid drugs and steroids.NCBI+1

8. Avoid: Crash diets or extreme calorie restriction, which can strain the body during active autoimmune disease and disturb medication balance.NCBI

9. Avoid without supervision: “Thyroid boosting” herbal products or unregulated supplements advertised online, which may contain iodine or thyroid hormone and can dangerously disturb hormone balance.NCBI+1

10. Balance: Maintain regular meal timing and hydration to support energy, mood, and safe use of medicines like beta-blockers and antithyroid drugs.NCBI+1

---

Frequently asked questions

1. Is Abadie’s sign dangerous by itself?
   Abadie’s sign itself is a sign, not a disease. It shows that the eyelid muscle is overactive, usually because of Graves’ disease and thyroid eye disease. The danger depends on how severe the underlying disease is and whether vision or corneal health are threatened.Wikipedia+2ULY CLINIC+2

2. Can Abadie’s sign go away?
   Yes, in many people the eyelid spasm and retraction improve when thyroid hormone is controlled and eye inflammation becomes inactive. Sometimes, however, surgery is needed to correct permanent lid retraction after disease has settled.NCBI+2EyeWiki+2

3. Is Abadie’s sign always caused by Graves’ disease?
   It is classically described in exophthalmic goiter due to Graves’ disease, but other causes of lid retraction and eye bulging can look similar. That is why full thyroid and eye evaluation is important rather than assuming the cause.Wikipedia+1

4. Can I treat this with home remedies only?
   No. Home measures like eye drops and cool compresses help comfort but cannot correct thyroid hormone imbalance or active orbital inflammation. Medical treatment is needed to prevent serious complications such as vision loss.EyeWiki+2NCBI+2

5. Are antithyroid drugs safe to take for a long time?
   Antithyroid drugs like methimazole can be used for months to years with regular monitoring. Rare but serious side effects such as severe low white-cell counts or liver injury mean that sudden sore throat, fever, or jaundice should be checked urgently.FDA Access Data+2FDA Access Data+2

6. Will I need thyroid surgery or radioiodine?
   Some patients are controlled long-term with antithyroid drugs. Others eventually need radioiodine or thyroidectomy for permanent control. The choice depends on age, disease severity, eye involvement, pregnancy plans, and personal preference.NCBI+2Wikipedia+2

7. Does teprotumumab cure thyroid eye disease?
   Teprotumumab can significantly reduce eye bulging and soft-tissue inflammation in many patients, but it does not remove the autoimmune tendency. Some people may still have residual changes or future flares, so follow-up remains essential.FDA Access Data+2FDA Access Data+2

8. Is selenium supplementation always recommended?
   Current guidelines mainly suggest selenium for mild, active TED, especially in areas where selenium intake is low. It should be used at medically advised doses, not as very high self-prescribed supplements.New England Journal of Medicine+2Frontiers+2

9. Can diet alone fix Graves’ disease or Abadie’s sign?
   Diet can support general health and may help manage risk factors, but it cannot replace antithyroid drugs, radioiodine, or surgery. Thyroid and eye problems need proper medical treatment.NCBI+2Wikipedia+2

10. Will my eyes always look “staring”?
    Some people improve a lot after disease control and, if needed, decompression and eyelid surgery. Others may keep some degree of prominence or retraction. Early treatment, smoking cessation, and modern therapies improve the chances of a better cosmetic result.EyeWiki+1

11. Can teenagers get Abadie’s sign and Graves’ disease?
    Yes, Graves’ disease can occur in teenagers and young adults, and the same eye signs can appear. Treatment in young people needs special care with growth, fertility, and long-term health in mind, so pediatric or adolescent specialists are often involved.NCBI+1

12. Is eye pain normal in thyroid eye disease?
    Mild ache and pressure can occur, but strong or sudden pain, especially with blurred vision, is a warning sign. It requires urgent eye-specialist review to rule out corneal ulcer or optic nerve compression.EyeWiki+1

13. Can I wear contact lenses if I have Abadie’s sign?
    During active disease with dryness, exposure, or corneal damage, contact lenses are usually not recommended. When the eye surface is stable and well lubricated, an ophthalmologist can advise whether special lenses are safe.EyeWiki

14. Will pregnancy affect my Graves’ disease and eye signs?
    Pregnancy can change immune activity and thyroid hormone needs. Some antithyroid drugs are safer in certain trimesters than others. Women with Graves’ disease or TED should plan pregnancy with their doctors and be monitored closely during and after pregnancy.NCBI+1

15. What is the most important step I can take right now?
    The single most important step is to see an endocrinologist and an eye specialist, follow their treatment plan, and stop smoking if you smoke. Early, steady care offers the best chance to control Graves’ disease, protect vision, and improve Abadie’s sign over time.NCBI+2EyeWiki+2

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: December o3 , 2025.