Graves ophthalmopathy after radiation treatment of thyroid cancer.
OBJECTIVE
To describe a patient with metastatic thyroid cancer who developed Graves ophthalmopathy after treatment with radioiodine (I 131) and external beam radiation.


METHODS
We present a case report that includes clinical, laboratory, and radiologic findings and a brief review of the literature.


RESULTS
A 49-year-old woman who had had a total thyroidectomy and neck dissection followed by I 131 treatment 5 years earlier for papillary thyroid cancer presented for follow-up management after recent neck dissection for recurrent disease. Because she had thyroglobulin antibodies, she was again treated with I 131 after preparation with recombinant human thyroid-stimulating hormone. A post-treatment scan revealed uptake in the right iliac crest. A fludeoxyglucose F 18 positron emission tomography/computed tomography fusion scan revealed osseous metastases in the right pelvis, and external beam radiotherapy was delivered to this area. Approximately 5 months later, she developed periocular swelling and excessive tearing. Magnetic resonance imaging of the orbits revealed enlargement of the extraocular muscles. Serum thyroid-stimulating immunoglobulins were greatly elevated.


CONCLUSIONS
This case corroborates an earlier report to suggest that radiation-associated thyroid injury in a patient with thyroid cancer may be followed by Graves ophthalmopathy and appearance of thyroid-stimulating immunoglobulins in the serum.
Woeber
Kenneth A
KA
Department of Medicine, University of California San Francisco, San Francisco, California 94143-1640, USA. ken.woeber@ucsf.edu
Schwartz
Lee K
LK
D005260:Female; D049970:Graves Ophthalmopathy / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects*; D013964:Thyroid Neoplasms / Q000473:pathology / Q000532:radiotherapy*
D007457:Iodine Radioisotopes