The disease curve for TED is pretty much set, though each stage can vary in length of time. We know that people who smoke cigarettes experience longer periods of time overall before final resolution. Here’s the general pattern that each TED patient follows.
First there is a "hot phase" which is the period of time where it seems as if your eyes have gone completely haywire ~ they protrude, go back, double vision comes and goes in various parts of the gaze, there’s just no rhyme or reason but everything’s crazy. Second there is a period of stability, where things may still be abnormal, but they no longer change rapidly. Third there is a period of improvement, and the AMOUNT of improvement ultimately achieved varies among TED patients. Finally there is the "cold phase," which is best diagnosed in hindsight ~ after a period of time has passed with NO changes at all, the ophthalmologist will feel comfortable diagnosing the cold phase. The doctor should be the one to tell you how much time needs to pass before they are comfortable with that diagnosis.
Prednisone or directed radiation (a beam to the eye socket) can be effective during the hot phase, in order to keep the changes to a minimum, but of course they carry their own risks. They are ineffective after the hot phase.
Surgical correction can be safely explored in the cold phase. It can be done in the earlier phases if absolutely necessary (to save the optic nerve), but it can trigger more activity that makes future corrections more difficult, if done in the hot phase.
I hope this helps!
