Ocular myasthenia gravis associated with euthyroid ophthalmopathy

Abstract

We report a 71-year-old woman with concomitant ocular myasthenia gravis and euthyroid Graves' ophthalmopathy. Unilateral ophthalmoplegia, including ptosis, initially was responsive to edrophonium and corticosteroids, except for diplopia on upward gaze, but refractory swelling of the inferior rectus muscle and proptosis followed. Autoantibodies to acetylcholine and thyrotropin receptors were detected. Her ophthalmopathy abated after orbital irradiation in combination with systemic steroids. There may be an immunological basis for the association of ocular myasthenia gravis with euthyroid Graves' ophthalmopathy.

Co-existence of Euthyroid Graves Ophthalmopathy and Isolated Ocular Myasthenia in a Patient with Vitiligo: A Challenging Diagnosis of Auto-immune Polyglandular Syndrome-3C

“…12,13 Thyroid associated orbitopathy is a symptom typical for Graves disease but it rarely accompanies Hashimoto disease. Moreover, there are even fewer reports of coincidental isolated OMG and euthyroid Graves ophthalmopathy occurring in the same patient 2,8 and to the best of our knowledge, this is the first report of isolated OMG associated with euthyroid ophtalmopathy and vitiligo in the same patient. Nevertheless, the diagnosis of the two apparently simultaneous ocular diseases has led to certain diagnostic problems in the present case, mainly because of the lack of the characteristic features of generalized MG and of the highly fluctuating character of the muscular weakness but also because of some test results.…”

“…About 10% of patients with Graves ophthalmopathy are euthyroid. 8 Almost all of those patients have at least one of the autoantibodies to thyroglobulin, TPO, and the TSH receptor in high titers. 22 It should be mentioned that the sensitivity of the TSH receptor autoantibody kit used in our study is approximately 98%.…”

Upper eyelid retraction disclosed after edrophonium chloride administration in a patient with Graves' orbitopathy and myasthenia gravis

“…Upper eyelid ptosis, typically suggestive of myasthenia gravis, may be seen with Graves’ orbitopathy as a result of levator myopathy,13 apical compression,14,15 and pseudoptosis secondary to upper eyelid retraction in the fellow eye 16. However, if ptosis develops in a patient with Graves’ orbitopathy, simultaneous myasthenia gravis should be considered,17 although ocular myasthenia gravis with orbital pain may imply orbital inflammation 18…”

The Clinicopathologic Basis of Graves' Ophthalmopathy: A Review

“…Other autoimmune diseases are seen with g reater frequency in patients with GD, e.g., myasthenia gravis. This can be a difficult diagnosis to appreciate in a patient who already has diplopia from GO (56,57).…”