Dr. Steven Raffin, Senior Assistant Resident in Medicine, Jewish Hospital of St. Louis, and Assistant in Medicine, Washington University School of Medicine: A 35-year-old white woman was hospitalized with a nine-month history of progressive "eye swelling," visual loss bilaterally, and frontal headaches. One year prior to admission, the diagnosis of hyperthyroidism had been established and subtotal thyroidectomy performed. The patient had been followed up subsequently in the outpatient clinic and continued to maintain the post-operative euthyroid state without supplemental thyroid medication. The most recent serum protein-bound iodine value, obtained one week prior to admission, was 4.5 μg/100 ml.
Physical examination revealed a well-developed woman in moderate distress. The blood pressure was 178/120 mm Hg; pulse rate was 76 beats per minute and regular, and respiratory rate was 18 per minute. The most striking findings were severe, bilateral papilledema, corneal ulcerations, proptosis, conjunctival edema, and chemosis (Fig 1, right). Also apparent