Exophthalmos and multinodular goitre, an unusual combination

Area of Science:

• Endocrinology
• Ophthalmology
• Radiology

Background:

• Multinodular goitre is generally not associated with eye disease, except in rare instances like Marine-Lenhart syndrome.
• Exophthalmos in patients with multinodular goitre necessitates ruling out other potential causes.
• Diagnostic challenges arise when patients present with Graves' ophthalmopathy features but lack thyroid-stimulating hormone receptor autoantibodies.

Purpose of the Study:

• To present a unique case of multinodular goitre coexisting with Graves' orbitopathy.
• To highlight the diagnostic dilemma posed by this rare combination.
• To emphasize the potential impact of iodine contrast agents on thyroid eye disease.

Main Methods:

• Case report of a 61-year-old male diagnosed with toxic multinodular goitre.
• Investigation of pre-syncopal attack and subsequent development of severe eye symptoms post-iodine contrast imaging (CT coronary angiogram).
• Diagnostic confirmation using Magnetic Resonance Imaging (MRI) of the orbit.

Main Results:

• The patient developed severe eye symptoms, suggestive of Graves' orbitopathy, following an iodine contrast-based study.
• MRI confirmed features consistent with Graves' orbitopathy.
• Despite pre-existing but non-classical eye symptoms, the presentation was complicated by the coexistence of multinodular goitre.

Conclusions:

• Graves' orbitopathy can occur in patients with multinodular goitre, even with normal thyroid autoantibodies.
• The absence of thyroid antibodies does not exclude Graves' orbitopathy.
• Iodine-containing compounds can exacerbate Graves' eye disease symptoms.