We most commonly associate thyroid eye disease as occurring in the context of Graves disease. However, the same immunologic processes that drive Graves thyroid eye disease can also occur in the context of hypothyroidism. Dr. Alex Tuttle woudl have just presented such a case this weekend at the annual Pediatric Endocrine Society meeting originally planned to occur in Texas. His presentation was entitled: “Active Thyroid Eye Disease in a Pediatric Patient with Hypothyroidism”. This serves as a reminder that it is important for even otherwise routine cases of hypothyroidism to receive expert care. Dr. Tuttle is completing his pediatric residency at the University of Iowa this year. We are thrilled that on July 1 he will join our division as a pediatric endocrine fellow. On this case report, he was mentored by pediatric thyroid expert Dr. Liuska Pesce.