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A 62-year-female presented with bilateral proptosis and 1 year episodic eye pain, grittiness, redness, watering and intermittent diplopia for 6 months, and drooping of right eye lid for 2 months (Figure 1). She had a firm WHO grade-1b goiter, exopthalmos (26 mm and 23 mm  in left and right eye respectively, Hertel exopthalmometer), clinical activity score of 1/6, without any evidence of bulbar, neck muscles and limb weakness.

Thyroid Associated Ophthalmopathy with Ocular Myasthenia in Primary Hypothyroidism