A clinical challenge: delayed diagnosis of autoimmune polyglandular syndrome type II in a patient with thyroid eye disease

A 35-year-old woman with thyroid eye disease (TED) was found to have autoimmune polyglandular syndrome type II (APS-II) 1 year after developing symptoms of this rare syndrome, during which she underwent 8 emergency department visits before receiving a targeted endocrinology workup. Thyroid disease is the second most common autoimmune syndrome associated with APS-II after primary adrenal insufficiency. Identification of this syndrome is critical as it can be life-threatening if left untreated. Additionally, if associated hypothyroidism is treated with levothyroxine, adrenal crisis can occur. The patient described symptoms, some of which overlapped with those of TED, and a significant delay in diagnosis occurred. Discussion of this patient's course highlights the importance of ophthalmologists keeping APS-II in mind when seeing patients with thyroid eye disease.