This presentation will describe the case of a 60-year-old woman who,after being hypothyroid for 12 years, developed severe thyroid associated opthalmopathy (TAO) and was found to be hyperthyroid. She had strongly positive anti-TSH receptor antibodies. She developed right optic nerve compression unresponsive to methylprednisolone and requiring orbital decompression at Moorfields Hospital in November 2000. She has subsequently required immunosuppressive therapy for severe TAO affecting the left eye and has received retro-orbital radiotherapy. She is now disabled by diplopia due to enophthalmos of the decompressed eye and muscle tethering of the right eye and is suffering side-effects from steroids.
Management of her hyperthyroidism has been complicated by jaundice and an acute arthropathy due to carbimazole and propylthiouracil, and intolerance of beta blockers because of asthma. She underwent total thyroidectomy in March 2001.
The case demonstrates an unusual mode of presentation of TAO and the importance of close liaison between endocrinologist, ophthalmologists and thyroid surgeon in the management of patients with severe TAO.