Seronegative Myasthenia Gravis and Graves’ Disease. Is there a link?

Polymeris, Antonis; Karoutsou, Eftychia; Doumouchtsis, Konstantinos

doi:10.1055/s-0032-1304598

Cited by 6 publications

(4 citation statements)

References 23 publications

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“…Cases showing equivocal negative results except MG included ischemic oculomotor nerve palsy with ptosis and thyroid associated ophthalmopathy. As ptosis is rare in thyroid associated ophthalmopathy and MG is more frequent in patients with thyroid disease [ 25 , 26 ], an equivocal negative result of the ice test may imply a ‘possible MG’ even if other test results are all negative for MG, and close observation for the symptoms of MG would be necessary.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of repeated ice tests in the evaluation of ptosis in myasthenia gravis

2017

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Twenty-six patients with ptosis related to Myasthenia gravis (MG) and 38 controls with ptosis other than MG were included. All patients were tested with the ice test 2 times on separate days in the afternoon. The margin reflex distance (MRD) was measured before and immediately after 2-minute application of ice on the eyelids. The ice test was judged positive if there was an improvement of at least 2.0 mm of MRD after the ice test. Among the patients with negative test results, 'equivocal’ was defined by improvement of MRD from at least 1.0 mm to less than 2.0 mm after the ice test. Repeated ice test results showed an agreement of 61.5% in MG, and 97.4% in nonmyasthenic ptosis. Repeated ice tests increased the sensitivity by 34.6% compared to a single test. Among the patients with repeatedly negative test results, 63.6% of those who showed equivocal results at least once turned out to be MG. Of those with repeated non-equivocal negative results, nobody turned out to be MG. There was no significant difference of the ice test results between ocular MG and generalized MG (p = 0.562).

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Section: Discussionmentioning

confidence: 99%

Diagnostic value of repeated ice tests in the evaluation of ptosis in myasthenia gravis

2017

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“…The association between the two diseases seems to be attributable to autoimmune mechanisms rather than simply by chance. Recent research has shown the involvement of autoantibodies, lymphocytes, cytokines, and chemokines in the pathogenesis of MG [ 17 ]. Thus, seropositive OMG may have a higher prevalence of thyroid autoantibodies and the autoimmunity between OMG and autoimmune thyroid diseases may be significantly correlated.…”

Section: Discussionmentioning

confidence: 99%

The Anti-Acetylcholine Receptor Antibody Test in Suspected Ocular Myasthenia Gravis

Lee

Koh

Kim

2014

Journal of Ophthalmology

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Aim. To estimate the clinical significance of anti-acetylcholine receptor antibody (anti-AChR-Ab) levels in suspected ocular myasthenia gravis. Methods. In total, 144 patients complaining of fluctuating diplopia and ptosis were evaluated for serum levels of anti-acetylcholine receptor antibody and their medical charts were retrospectively reviewed. Subjects were classified into three groups: variable diplopia only, ptosis only, and both variable diplopia and ptosis. We investigated serum anti-AChR-Ab titer levels and performed thyroid autoantibody tests. Results. Patients' chief complaints were diplopia (N = 103), ptosis (N = 12), and their concurrence (N = 29). Abnormal anti-AChR-Ab was observed in 21 of 144 patients (14.1%). Between the three groups, mean age, number of seropositive patients, and mean anti-AChR-Ab level were not significantly different (P = 0.224, 0.073, and 0.062, resp.). Overall, 27.5% of patients had abnormal thyroid autoantibodies. Conclusion. The sensitivity of anti-AChR-Ab was 14.1% in suspected ocular myasthenia gravis and seropositivity in myasthenia gravis patients showed a high correlation with the presence of thyroid autoantibodies.

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“…Table 2 summarizes the clinical features of each case, many of which highlight the difficulties in making a dual diagnosis. [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] In prospective and retrospective series of patients with TED, 0.7% to 1.3% will also be diagnosed with MG. 11,47,48 Of patients with coexisting TED and MG, isolated OMG is more common than the generalized form. 49,50 Most MG patients with coexisting TED tend to have a benign course and rarely require treatment beyond symptomatic therapy with AChEIs, but more severe cases requiring intubation and systemic immunotherapy have been reported.…”

Section: Coexisting Omg and Tedmentioning

confidence: 99%

“…We performed a PubMed search in the English literature focusing on publications since 1980. Table 2 summarizes the clinical features of each case, many of which highlight the difficulties in making a dual diagnosis 31‐46 …”

Section: Clinical Presentationmentioning

confidence: 99%

Challenges in diagnosing coexisting ocular myasthenia gravis and thyroid eye disease

Claytor

2020

Muscle and Nerve

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Ocular myasthenia gravis (OMG) and thyroid eye disease are two autoimmune conditions that have several overlapping clinical features, and these coexist with a small but not insignificant frequency. Segregating these diagnoses is typically straightforward, but, when the two diseases co‐occur in the same individual, making a diagnosis of OMG can be very challenging. In this review we address what is known about the coexistence of OMG and thyroid eye disease and we highlight the clinical features that are suggestive of overlapping conditions. We also describe the major testing approaches used in the diagnosis of these two entities, with special emphasis on the potential shortcomings of individual tests in patients with overlapping disease. In patients with thyroid eye disease, securing a diagnosis of OMG may not be possible on the basis of a single positive test. A multimodal approach using clinical, serologic, imaging, and electrodiagnostic data, is typically required.

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Seronegative Myasthenia Gravis and Graves’ Disease. Is there a link?

Cited by 6 publications

References 23 publications

Diagnostic value of repeated ice tests in the evaluation of ptosis in myasthenia gravis

Diagnostic value of repeated ice tests in the evaluation of ptosis in myasthenia gravis

The Anti-Acetylcholine Receptor Antibody Test in Suspected Ocular Myasthenia Gravis

Challenges in diagnosing coexisting ocular myasthenia gravis and thyroid eye disease

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