Aggravated Orbitopathy Following Remnant Ablation in a Patient with Multiple Cancers

ABSTRACT

The rate of thyroid cancer in the patients with Graves’ disease is controversial. The rare incidents of multiple primary thyroid cancers in the same patient have been reported. The coexistence of multiple primary thyroid cancers in patients with autoimmune thyroiditis is even rarer. The eye findings may worsen following radioactive iodine (RAI) therapy for thyrotoxicosis in Graves’ disease. In this case report, we present a patient with Graves’ disease with a pathological diagnosis of papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) having aggravated orbitopathy following remnant ablation. A 53-year-old non-smoker female was diagnosed with Graves’ disease and underwent total thyroidectomy after the eye findings became more evident two months after the initiation of an anti-thyroid drug. The patient was pathologically diagnosed as having an underlying 3-cm FTC and 3-mm PTC. Furthermore, the patient received 100 mCi of RAI under steroid cover for the remnant ablation. The patient did not comply with the glucocorticoid therapy and the eye findings were aggravated, thus requiring orbital decompression therapy. The aggravation of orbitopathy can be observed following remnant ablation for thyroid cancer in patients with Graves’ disease, and glucocorticoid prophylaxis may be considered in patients with active Graves’ orbitopathy.