Total thyroidectomy is one of the definitive treatments for Graves disease. This case describes the rare recurrence of thyroid eye disease (TED) and thyrotoxicosis due to thyroid remnant tissue. We present a 58 year old lady with Graves disease first seen in 2005 with positive TSH receptor antibodies (TSHRab) level of 2.5 U/l. She had a large multinodular goiter at presentation and this continued to grow with retrosternal extension and subsequent tracheal deviation. She underwent total thyroidectomy in 2014. At this point she had mild TED treated with lubricant eye drops. She had stable thyroid functions on levothyroxine (125 micrograms od). Two years later she developed sudden thyrotoxicosis and her thyroxine replacement was stopped. Her thyrotoxicosis persisted and she developed worsening TED needing opthalmology input. Her TSHRab levels were now high at 26.4 U/l. Technetium (Tc) thyroid uptake scan demonstrated mediastinal thyroid remnant low in the thoracic cavity. Her thyroid remnant would have required thoracotomy for removal. She was commenced on Carbimazole titration therapy with coninued ophthalmology input. Her latest thyroid functions are normal on Carbimazole with stable eye disease. She is now considering radioactive iodine tharapy under steroid cover as definitive therapy for her Graves disease. This case describes the importance of considering thyroid remnant tissue in recurrent. TED and Graves disease post thyroidectomy.
19 Nov 2018 - 21 Nov 2018