Concurrent Graves disease thyrotoxicosis and myasthenia gravis: the treatment of the former may dangerously reveal the latter

Lakhal, Karim; Blel, Youssef; Fysekidis, Marinos; Mohammedi, Kamel; Bouadma, Lila

doi:10.1111/j.1365-2044.2008.05496.x

Cited by 12 publications

(9 citation statements)

References 25 publications

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“…While Fang et al [12] recently published an article that showed higher rate of association than our study result. In addition, previous studies also support our result and mentioned the significance relationship between thyroid disorders and myasthenia gravis [9, 13-15]. The association of MG and AITD has been identified in autoimmune polyendocrine syndrome type Il (APS-II), which comprises Addison’s disease, AITD (GD and hypothyroidism caused by chronic lymphocytic thyroiditis), MG, type 1 diabetes, and others [16].…”

Section: Discussionsupporting

confidence: 88%

The concomitant association of thyroid disorders and Myasthenia gravis

Lin

Iqbal

Nguyen³

et al. 2017

Translational Neuroscience

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BackgroundSome of the thyroid disorders (TD) and Myasthenia gravis (MG) are autoimmune related disease. The purpose of the study to evaluate the relationship of MG with all morphological and functional thyroid disorders.MethodsWe constructed a population-based cohort study during the period from January 2000-December 2002 by using reimbursement data from the Bureau National Health Insurance (NHI) system in Taiwan. Patients with TD and MG were identified by referring to the ICD-9-CM codes. (ICD-10-CM as reference) .The association of TD with MG occurred only in the same person within the study period. The Q value was used to measure the strength of disease-disease associations.ResultsWe obtained 520628 TD and 7965 MG records for analysis. Diffuse toxic goiter had highest association rate, followed by nontoxic nodular goiter, simple goiter, chronic lymphocytic thyroiditis, thyroid cancer, and toxic nodular goiter. Female and older patients had a higher rate than their male and younger counterparts, respectively. Functional abnormalities revealed higher incidence of thyrotoxicosis and hypothyroidism in both sexes. We also found the strongest association in men with chronic thyroiditis, diffuse toxic goiter, thyrotoxicosis, acquired hypothyroidism, thyroid cancer, and simple goiter. While an intermediate association was observed in female with diffuse toxic goiter, in a male with toxic and nontoxic nodular/multinodular goiters, in female with thyrotoxicosis, thyroid cancer and acquired hypothyroidism.ConclusionThis population based cohort study showed potential association of all types of TD with MG, and observed a higher association rate in female autoimmune TD whereas males showed a higher strength of association.

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Section: Discussionsupporting

confidence: 88%

The concomitant association of thyroid disorders and Myasthenia gravis

Lin

Iqbal

Nguyen³

et al. 2017

Translational Neuroscience

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“…[4] This association of MG and hyperthyroidism is considered to be due to a common autoimmune mechanism. [6,7] In 75% of patients, symptoms of hyperthyroidism occur before or concurrently with those of MG. Thymic hyperplasia is usually associated with hyperthyroidism. [8] There is a positive relation between the two circulating antibodies against TSH and acetylcholine receptors and they might influence the clinical manifestations of each other.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that pharmacologic management of hyperthyroidism results in the resolution of myasthenia-like symptoms and regression of thymic hyperplasia concomitant with normalization of thyroid functions, [9,4,10] but there can be deterioration also. [7,8,11] This paradoxical phenomenon has been described as a see-saw balance; [11] when myasthenic manifestations increase, thyrotoxic symptoms decrease, and vice-versa. A reverse see-saw relationship has also been reported.…”

Section: Discussionmentioning

confidence: 99%

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Anesthetic management of patient with myasthenia gravis and uncontrolled hyperthyroidism for thymectomy

et al. 2010

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The relationship between myasthenia gravis (MG) and other autoimmune disorders like hyperthyroidism is well known. It may manifest earlier, concurrently or after the appearance of MG. The effect of treatment of hyperthyroidism on the control of MG is variable. There may be resolution or conversely, deterioration of the symptoms also. We present a patient who was diagnosed to be hyperthyroid two and half years before the appearance of myasthenic symptoms. Pharmacotherapy for three months neither improved the myasthenic symptoms nor the thyroid function tests. Thymectomy resulted in control of MG as well as hyperthyroidism. In conclusion, effective control of hyperthyroidism in the presence of MG may be difficult. The authors opine that careful peri-operative management of thymectomy is possible in a hyperthyroid state.

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“…B-blokery, a najbardziej Propranolol zaburzają przewodnictwo nerwowo-mięśniowe i są przeciwskazane u pacjentów z miastenią. Istnieją doniesienia o nasileniu objawów , a także ujawnianiu się miastenii u pacjentów leczonych b-blokerami [60][61][62][63][64][65][66]. Być może również u naszej pacjentki zastosowanie takiego leczenia doprowadziło do nagłego pogorszenia stanu ogólnego i wystąpienia objawów miastenii pod postacią zaburzeń połykania i oddychania.…”

Section: Dyskusjaunclassified

Graves` disease and myasthenia gravis in a teenager – diagnostic problems

Bury¹,

Klatka²

2015

Pediatr. Endocrinol.

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Przyjmuje się, że u podłoża autoimmunologicznych zespołów niewydolności wielogruczołowej leży defekt genetyczny dziedziczony bądź będący wynikiem świeżej mutacji, a także polimorfizm dotyczący układu antygenów zgodności tkankowej HLA. Za allele predysponujące do wystąpienia chorób autoimmunologicznych uważa się: DRB1*03 i/lub 04, DQA1*0301 i/lub *0501 oraz DQB1*0302 i/lub 0201, natomiast allele protekcyjne to: DRB1*1501 i/lub *07 i /lub *11, DQA1*0102 i/lub 0201 oraz DQB1*0602 i/lub 0301 [1]. Do rozwoju chorób autoimmunologicznych u osób predysponowanych genetycznie przyczynia się współwystępowanie różnych czynników środowiskowych, do których zalicza się między innymi: infekcje bakteryjne i wirusowe, urazy, leki, promieniowanie ultrafioletowe, stres, dietę [2,3]. Fakt, że chorują częściej kobiety w okresie prokreacyjnym, zwraca uwagę na potencjalną rolę estrogenów, progesteronu czy prolaktyny w rozwoju powyższych jednostek chorobowych [4,5]. Chociaż prawie każdy organ może być celem ataku autoimmunologicznego, liczne badania podkreślają, że układ endokrynny jest szczególnie podatny (wrażliwy, nieodporny) na tego typu oddziaływania. Choroby autoimmunologiczne tarczycy, wysptrzustki i kory nadnerczy stanowią ponad 50% wszystkich chorób autoimmunologicznych narządowospecyficznych [6]. Coraz więcej jest również dowodów na interakcje pomiędzy układem immu

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Concurrent Graves disease thyrotoxicosis and myasthenia gravis: the treatment of the former may dangerously reveal the latter

Cited by 12 publications

References 25 publications

The concomitant association of thyroid disorders and Myasthenia gravis

The concomitant association of thyroid disorders and Myasthenia gravis

Anesthetic management of patient with myasthenia gravis and uncontrolled hyperthyroidism for thymectomy

Graves` disease and myasthenia gravis in a teenager – diagnostic problems

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