Bilateral Horner's Syndrome Secondary to

thyroid disease due to cervical sympathetic nerve damage ( 1- 3). A l though goiter is often considered to cause Hor-ner's syndrome, there is little documentat ion. An 80-year-old woman was evaluated for bilateral ptosis. She had had a multinodular goiter since her teens, but with no symptoms of hyperthyroidism or hypothyroidism, or tracheal or esophageal compression. Her goiter was roughly 200 g, with a surface area of 6 X 7 cm left of midline and 5 x 4 cm to the right and was unchanged from measurements recorded 10 years earlier. She had bilateral ptosis. Her pupils were 2.5 mm, reac-tive to 1.5 mm with light. The rest of her examination was normal. The patient's miosis and ptosis suggested bilateral Horner's syndrome. Topical cocaine solution (10%) elicited only mini-mal pupillary enlargement (increase to 3 mm). Hydroxy