The case record of a 35 year old male patient with highly active Grave
s' disease and ophthalmopathy is presented. Because of the deteriorati
on of the ophthalmopathy (18 months after first symptomes) a total thy
roidectomy was performed, microscopical examination of the tissue reve
aled a papillary carcinoma (pT2, pN1, pM0) of the left thyroid lobe (p
reoperative investgations had shown a diffuse enlargement of this lobe
without any abnormalities of structure in ultrasound and scintigraphy
, no suspicion of malignancy). Radioiodine therapy (2.96 GBq I-131) wa
s performed, during the hypothyroid phase further deterioration of vis
us (0.5) occurred. A surgical decompression of both orbitae was perfor
med, additionally a newly diagnosed metastatic lymph node was exstirpa
ted. Postoperatvely improvement of visus (0.8), 3 month later whole bo
dy scan and Tg-levels were negative. The prevalence of differentiated
thyroid carcinoma in patients with Graves' disease (which is not highe
r than in other forms of hyperthyroidism [e.g. thyroid autonomy]) is d
iscussed.