He was diagnosed with primary hyperthyroidism and proptosis (Graves’ disease) 2 years ago and relapsed after remission with oral anti-thyroid medication (methimazole). The patient was treated with two isotope 131I ablations. Surgery: total bilateral thyroidectomy + lymph node dissection in left VI, III and IV areas. Intraoperatively, we saw bilateral thyroid atrophy, the left thyroid gland was 2 cm in diameter in the middle and lower pole, hard and adherent to the anterior cervical muscles, and the lymph nodes in areas VI and IV were obviously enlarged.