Thyroid remnant radioiodine ablation in a case of concurrent thyroid carcinoma, Graves' disease, and thyroid ophthalmopathy.

High-dose I-131 thyroid remnant ablation postthyroidectomy for differentiated thyroid carcinoma is beneficial but the risk of visual complications including loss of vision in patients with coexisting Graves' ophthalmopathy is not well documented. We report the case of a 42-year-old man who presented for radioiodine ablation post total thyroidectomy for metastatic papillary carcinoma, who also had Graves' ophthalmopathy and juvenile onset glaucoma. Concurrent presence of all these conditions in the same patient is rarely encountered and this case demonstrates the challenge faced by the clinicians in balancing the benefits and risks of currently recommended management strategies for these conditions. There is a potential risk of visual complications with I-131 therapy in patients with Graves' disease as it can lead to development of or exacerbation of preexisting ophthalmopathy. The acute exacerbation is usually transient and preventable with prophylactic corticosteroids. However, the use of corticosteroids is associated with various complications including exacerbation of glaucoma as demonstrated in this patient.