We describe the use of optical coherence tomography angiography (OCTA) to investigate the relationship between thyroid-stimulating hormone receptor autoantibody (TSHR Ab) levels and retinal vessel and choroid changes in patients with thyroid eye disease (TED). Methods: We enrolled 23 TED patients with abnormal TSHR Ab levels (>1.5 IU/L; all right eyes). Sex, visual acuity, intraocular pressure and TSHR Ab level were recorded at baseline and after 1 month. We used OCTA to determine the size of the superficial and deep foveal avascular zones (sFAZ and dFAZ, respectively), as well as the 1-mm foveal and 3-mm parafoveal superficial capillary plexus density (sCPD) and choroidal thickness (CT), at baseline and after 1 month later. Results: The mean age of the 23 patients was 43.30 ± 16.16 years and 18 were female (78%). The mean baseline TSHR Ab level was 11.47 ± 11.22 IU/L. The TSHR Ab level showed non-significant correlations with sFAZ and dFAZ size, and with the 1-mm foveal sCPD; the correlation coefficients were 0.173, 0.073, and 0.266, respectively (p = 0.465, p = 0.759, and p = 0.224, respectively). The 3-mm parafoveal sCPD and CT showed non-significant correlations with the TSHR Ab level; the correlation coefficients were -0.185 and -0.16 (p = 0.421, p = 0.487). Conclusions: In TED patients, changes in TSHR Ab level over 1 month do not affect retinal blood flow or CT, but show a non-significant positive association with the 1-mm foveal sCPD.