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Ocular myasthenia gravis presenting with Graves disease - a case report

MOHANA PRIYA GAJARAJAN

Abstract


The coexistence of Graves disease and
myasthenia gravis - two distinct autoimmune
disorders directed against membrane
receptors TSH R and Ach R respectively
has been well documented.
We are reporting a case of Ossermans
grade I restricted ocular myasthenia gravis
presenting with Graves disease with
an aim to review literature on the optimal
management of these two coexisting disorders.
A 38 year old man presented with
ptosis about a year after the onset of
Graves disease. He was diagnosed to
have ocular myasthenia as he tested
positive for Ach R Ab. He was managed
with antithyroid drugs, cholinesterase inhibitors,
and steroid. After attaining
euthyroidism a total thyroidectomy with
extended trans-sternal thymectomy was
performed. He was relieved of his ocular
symptoms. Ptosis in a patient with
Graves disease should prompt one to
investigate for myasthenia gravis.
Surgery done for both the disorders at the
same sitting has a favourable outcome


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References


Rennie GE. Exopthalmic goiter

combined with myasthenia gravis.

Rev Neurol Psychiat 1908 ;6:229-

.

Kiess ling WR, Finke R, Kotulla

P ,et al. Circulating TSH binding inhibiting

immunoglobulins in Myasthenia

Gravis . Acta Endocrinol 1982 ;

: 41-6 .

Osserman K E. Myasthenia gravis.

NewYork , NY : Gune and Stratton.

Sekiguchi Y, Hara Y , Takahashi

M ,Hirata Y. Reverse see- saw Relationship

between Graves Disease

and Myasthenia gravis; Clinical and

immunological studies. Jour Med

Den Sci 2005; 52 : 43—50

Peacey SR, Belchetz PE. Graves

Disease: associated ocular Myasthenia

Gravis and a thymic cyst . Journal

of the Royal Society of Medicinevol

May 1993 297 – 98

Garlepp MJ , Dawkins RL ,

Christianson FT .Autoimmunity in

ocular and generalised Myasthenia

Gravis . J. Neuroimmunol. 1981; 1:

– 32.

Ken DF , Warren S. Organ specific

autoimmune diseases , Diagnostic Immunology.

Williams Wilkins , Baltimore

: 117- 138.

Abo T, Kawamura T ,Watanabe H .

Physiological responses of extrathymic

T cells in the liver . Immunol Rev 2000;

: 135 – 149.

McEachern D , Parnell JL .The relationship

of hyperthyroidism to Myasthenia

Gravis. J Clin Endocrinol Metab

. 1948;8: 842 – 850 .

Blalock A, Mason MF, Morgan HJ ,

Riven SS. Myasthenia Gravis and tumours

of the thymic region : Report of

a case in which the tumour was removed.

Ann Surg 1939; 110: 544-561 .

Ryunosuke Hase, Hiroshi Takahashi

, Eiji Simozawa , Satoshi Kondo.

Clinical outcomes following extended

thymectomy for Myasthenia Gravis.

Report of 17 cases. Ann Thorac Cardiovasc

surg. 2006 ; 12 : 203 -6

Nussbaum MS , Rosenthal GJ ,

Samaha FJ et al. Management of myasthenia

gravis by extended thymectomy

with anterior mediastinal dissection

. Surgery 1992 ; 112: 681 – 688.

Frist WH , Thirumalai S, Doering

CB et al . Thymectomy for the myasthenia

gravis patient : factors influencing

outcome. Ann Thoracic surgery.

; 57 : 334 – 338.

Peter L Abt, Himshu J Patel, Anne

Marsh, Seymour I Schwartz. J Am Coll

Surg 2001; 192 : 459 –464 .

Roberts PF, Venuta F , Rendina E ,

DeGiacomo T , Coloni GF, Follete DM ,

Richman DP Benfield JR . Thymectomy

in the treatment of ocular myasthenia

gravis . J Thorac Cardiovasc

Surg . 2001 sep ; 122(3) 562 -8.

Schumm F , Weitholter H , Fateh

Moghadham A, Dichgans J . Thymectomy

in myasthenia gravis with pure

ocular symptoms . Journal of Neurology

, Neurosurgery , and Psychiatry

; 48 : 332 –337 .

Michael Benatar , Henry Kaminski .

Medical and Surgical treatment for ocular

myasthenia. Cochrane library .

Brickman CM ,Shonfeld Y. The mosaic

of autoimmunity . Scand J Clin

Lab Invest 2001; 61 : 3 –15


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