{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:02Z","timestamp":1784557022433,"version":"3.55.0"},"reference-count":26,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2019,5,3]],"date-time":"2019-05-03T00:00:00Z","timestamp":1556841600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,5,3]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Multinodular goitre is not associated with eye disease, unless in a rare case of Marine\u2013Lenhart syndrome where it coexists with Grave\u2019s disease. Therefore, other causes of exophthalmos need to be ruled out when the eye disease is seen in a patient with multinodular goitre. Confusion can arise in patients with features suggestive of Graves\u2019 ophthalmopathy in the absence of thyroid-stimulating hormone receptor autoantibodies and no evidence of other causes of exophthalmos. We present a case of multinodular goitre in a patient with exophthalmos which flared up after iodine contrast-based study. A 61-year-old Australian presented with a pre-syncopal attack and was diagnosed with toxic multinodular goitre. At the same time of investigations, to diagnose the possible cause of the pre-syncopal attack, computerised tomographic (CT) coronary artery angiogram was requested by a cardiologist. A few days after the iodine contrast-based imaging test was performed, he developed severe eye symptoms, with signs suggestive of Graves\u2019 orbitopathy. MRI of the orbit revealed features of the disease. Although he had pre-existing eye symptoms, they were not classical of thyroid eye disease. He eventually had orbital decompressive surgery. This case poses a diagnostic dilemma of a possible Graves\u2019 orbitopathy in a patient with multinodular goitre.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>Learning points:<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Graves\u2019 orbitopathy can occur in a patient with normal autothyroid antibodies. The absence of the thyroid antibodies does not rule out the disease in all cases.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Graves\u2019 orbitopathy can coexist with multinodular goitre.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Iodine-based compounds, in any form, can trigger severe symptoms, on the background of Graves\u2019 eye disease.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-18-0138","type":"journal-article","created":{"date-parts":[[2019,5,3]],"date-time":"2019-05-03T07:05:40Z","timestamp":1556867140000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":0,"title":["Exophthalmos and multinodular goitre, an unusual combination"],"prefix":"10.1530","volume":"2019","author":[{"given":"Kingsley","family":"Okolie","sequence":"first","affiliation":[{"name":"1National Health Coop, Canberra, Australian Capital Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Chen","sequence":"additional","affiliation":[{"name":"2St. Vincent\u2019s Hospital, Darlinghurst, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raf","family":"Ghabrial","sequence":"additional","affiliation":[{"name":"3University of Sydney Medical School, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Schmidli","sequence":"additional","affiliation":[{"name":"4Canberra Hospital, Woden, Canberra, Australian Capital Territory, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"ref21","first-page":"222","article-title":"Pathogenesis of thyroid eye disease \u2013 does autoimmunity against the TSH receptor explain all cases?","volume":"61","year":"2010","journal-title":"Endokrynologia Polska"},{"key":"ref61","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1089\/10507250150500630","article-title":"Association of the HLA-DRB1*0301 and HLA-DQA1*0501 alleles with Graves\u2019 disease in a population representing the gene contribution from several ethnic backgrounds","volume":"11","year":"2001","journal-title":"Thyroid"},{"key":"ref91","doi-asserted-by":"crossref","first-page":"991","DOI":"10.1089\/105072503322511418","article-title":"Marine Lenhart syndrome","volume":"13","year":"2003","journal-title":"Thyroid"},{"key":"ref201","first-page":"1","article-title":"Jod-Basedow phenomenon: reactivation of thyroid eye disease after contrast computed tomography","volume":"77","year":"2018","journal-title":"African Vision and Eye Health"},{"key":"ref231","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1089\/105072502753600223","article-title":"Orbital radiotherapy for Graves\u2019 ophthalmopathy","volume":"12","year":"2002","journal-title":"Thyroid"},{"key":"ref01","first-page":"160008","article-title":"Thyroid antibody negative euthyroid Graves\u2019 ophthalmopathy","volume":"2016","year":"2016","journal-title":"Endocrinology, Diabetes and Metabolism Case Reports"},{"key":"ref51","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1210\/er.2002-0020","article-title":"Current perspective on the pathogenesis of Graves\u2019 disease and ophthalmopathy","volume":"24","year":"2003","journal-title":"Endocrine Reviews"},{"key":"ref131","first-page":"160008","article-title":"Thyroid antibody negative euthyroid Graves\u2019 ophthalmopathy","volume":"2016","year":"2016","journal-title":"Endocrinology, Diabetes and Metabolism Case Reports"},{"key":"ref171","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.3892\/ol.2011.411","article-title":"Association of insulin-like growth factor-1 with thyroid nodules","volume":"2","year":"2011","journal-title":"Oncology Letters"},{"key":"ref121","first-page":"1","article-title":"Targeted biological therapies for Graves\u2019 disease and thyroid-associated ophthalmopathy. 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Focus on B-cell depletion with rituximab","volume":"74","year":"2010","journal-title":"Clinical Endocrinology"},{"key":"ref151","first-page":"222","article-title":"Pathogenesis of thyroid eye disease \u2013 does autoimmunity against the TSH receptor explain all cases?","volume":"61","year":"2010","journal-title":"Endokrynologia Polska"},{"key":"ref11","first-page":"1547","article-title":"Graves\u2019 ophthalmopathy with negative autoantibodies","volume":"97","year":"2005","journal-title":"Journal of the National Medical Association"},{"key":"ref71","first-page":"1","article-title":"Jod-Basedow phenomenon: reactivation of thyroid eye disease after contrast computed tomography","volume":"77","year":"2018","journal-title":"African Vision and Eye Health"},{"key":"ref101","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1089\/105072502753600223","article-title":"Orbital radiotherapy for Graves\u2019 ophthalmopathy","volume":"12","year":"2002","journal-title":"Thyroid"},{"key":"ref111","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1210\/jc.2010-1962","article-title":"Intravenous glucocorticoids for Graves\u2019 orbitopathy: efficacy and morbidity","volume":"96","year":"2011","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.3892\/ol.2011.411","article-title":"Association of insulin-like growth factor-1 with thyroid nodules","volume":"2","year":"2011","journal-title":"Oncology Letters"},{"key":"ref241","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1210\/jc.2010-1962","article-title":"Intravenous glucocorticoids for Graves\u2019 orbitopathy: efficacy and morbidity","volume":"96","year":"2011","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref141","first-page":"1547","article-title":"Graves\u2019 ophthalmopathy with negative autoantibodies","volume":"97","year":"2005","journal-title":"Journal of the National Medical Association"},{"key":"ref211","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1056\/NEJMoa1614949","article-title":"Teprotumumab for thyroid-associated ophthalmopathy","volume":"376","year":"2017","journal-title":"New England Journal of Medicine"}],"container-title":["Endocrinology, Diabetes &amp; Metabolism Case Reports"],"original-title":[],"link":[{"URL":"https:\/\/edm.bioscientifica.com\/view\/journals\/edm\/2019\/1\/EDM18-0138.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/edm.bioscientifica.com\/downloadpdf\/journals\/edm\/2019\/1\/EDM18-0138.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:46:59Z","timestamp":1784555219000},"score":1,"resource":{"primary":{"URL":"http:\/\/journals.bioscientifica.com\/edm\/article\/35331"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,5,3]]},"references-count":26,"URL":"https:\/\/doi.org\/10.1530\/edm-18-0138","relation":{},"ISSN":["2052-0573"],"issn-type":[{"value":"2052-0573","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,5,3]]}}}