Thyroid associated ophthalmopathy (TAO), a cardinal clinical pointer to diagnose Graves' disease (GD), is seen less frequently in our country than in the West, but can have sight threatening consequences. Smoking, diabetes, male gender, increasing age and radioactive iodine treatment for thyrotoxicosis are known precipitating factors for TAO. We report four cases of thiazolidinediones (TZD) precipitated TAO. All were male, had autoimmune thyroid disease (three had Graves' disease and one had Hashimoto's thyroiditis) and type 2 diabetes mellitus (T2DM). They developed eye symptoms three to four months after taking TZDs for glycaemic control. Two of them responded to medical treatment, the other two underwent surgical decompression.