Multinodular goitre is not associated with eye disease, unless in a rare case of Marine–Lenhart syndrome where it coexistswith Grave’s disease. Therefore, other causes of exophthalmos need to be ruled out when the eye disease is seen in apatient with multinodular goitre. Confusion can arise in patients with features suggestive of Graves’ ophthalmopathy inthe 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-basedstudy. A 61-year-old Australian presented with a pre-syncopal attack and was diagnosed with toxic multinodular goitre. Atthe 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 wasperformed, he developed severe eye symptoms, with signs suggestive of Graves’ orbitopathy. MRI of the orbit revealedfeatures of the disease. Although he had pre-existing eye symptoms, they were not classical of thyroid eye disease. Heeventually had orbital decompressive surgery. This case poses a diagnostic dilemma of a possible Graves’ orbitopathy in apatient with multinodular goitre.
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