CASE REPORT Successful Treatment of Hypothyroid Graves9 Disease with a Combination of Levothyroxine Replacement, Intravenous High-Dose Steroid and Irradiation to the Orbit

A 46-year-old womanwith hypothyroid Graves' disease (EMOsyndrome) is reported. The patient had bilateral exophthalmos, conjunctival chemosis, periorbital edema and limitation of lateral gaze. Laboratory examination revealed the presence of primary hypothyroidism with positive thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin and thyroid stimulation antibody. These fiindings indicated a diagnosis ofhypothyroid Graves' disease or EMO syndrome. She received levothyroxine replacement and steroid pulse therapy followed by radiotherapy. Her visual symptomsshowed marked improvement and pretibial myxedemadisappeared. Although several studies indicate that hypothyroid Graves' disease is a different entity from hyperthyroid Graves' disease, this report suggests that steroid pulse therapy combined with radiotherapy may be effective to treat ophthalmopathy in both diseases. (Internal Medicine 32: 421-423, 1993)