Myasthenia Gravis and its Association With Thyroid Diseases

Amin, Saba; Myat, Aung; Gandhi, Fenil; Escobar, Julio A Pena; Gulraiz, Azouba; Malik, Bilal Haider

doi:10.7759/cureus.10248

Cited by 17 publications

(14 citation statements)

References 34 publications

(45 reference statements)

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“…Treating one pathology may worsen the other pathology. Therefore, physicians should always treat MG as a difference in patients with hyperthyroidism who have new symptoms of fatigue, respiratory failure or neuromuscular weakness [ 4 ]. Conditions such as operation and infection and such medicines as anesthetics, benzodiazepines, or even antibiotics may induce a myasthenia crisis.…”

Section: Discussionmentioning

confidence: 99%

Rare concurrent ocular myasthenia gravis and Graves’ ophthalmopathy in a man with Poland syndrome: a case report

Tang

Qin

2020

BMC Neurol

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Background Ocular myasthenia gravis and Graves’ ophthalmopathy are autoimmune diseases that are mediated by membrane receptors and share many identical clinical processes. Poland syndrome is a rare congenital deformity characterized by defects of the ipsilateral hand and the chest wall, and it is usually associated with hypoplasia of ipsilateral pectoral muscles and homolateral breast. However, to the best of our knowledge, the co-occurrence of these diseases has never been reported. In this study, we present a man with Poland syndrome who was diagnosed with Graves’ ophthalmopathy and ocular myasthenia gravis in succession. Case presentation A 43-year-old man presented with bilateral upper eyelid ptosis, bilateral eye protrusion, bilateral eye movement disorder and malformation of the right hand. Asymmetrical malformation of the chest wall and ipsilateral hand deformity were shown as Poland syndrome. He was diagnosed with ocular myasthenia gravis and Graves’ ophthalmopathy on the basis of clinical manifestations and laboratory examinations, including bilateral exophthalmos and progressive asymmetrical ophthalmoparesis without pupillary dysfunction, positive autoantibody tests, repetitive nerve stimulation tests, and computed tomography scans. Treatments with pyridostigmine bromide, thymectomy, and prednisone led to partial clinical improvement. After 13 months of follow-up, the symptoms of drooping eyelids were partially improved, but the eyeball protrusion and right hand deformity remained unchanged. Conclusions We report the first case of co-occurrence of ocular myasthenia gravis, Graves’ ophthalmopathy, and Poland syndrome. Genetic predisposition and immune dysregulation might be the pathogenesis of the association.

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Section: Discussionmentioning

confidence: 99%

Rare concurrent ocular myasthenia gravis and Graves’ ophthalmopathy in a man with Poland syndrome: a case report

Tang

Qin

2020

BMC Neurol

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“…This may be related to the fact that both of them share a common genetic background. 3 It has been shown in previous studies that the incidence of ocular MG is higher in cases of abnormal thyroid autoimmunity. 4 However, the prevalence of thyroid disease varies from study to study, and it is not yet known whether the clinical features and course of disease in these patients are different from those in patients without hyperthyroidism.…”

Section: Introductionmentioning

confidence: 94%

Analysis of clinical features of myasthenia gravis complicated with hyperthyroidism

Wang

Qi²,

Yang³

2022

Pak J Med Sci

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Objectives: To investigate the clinical features of patients with myasthenia gravis complicated with and without hyperthyroidism. Methods: A total of 2083 patients with myasthenia gravis (MG) admitted in Center of Treatment of Myasthenia Gravis Hebei Province between January 2013 and July 2020 were retrospectively analyzed and divided into two groups: Group-A and Group-B, with 108 MG patients complicated with hyperthyroidism in Group-A and 1975 MG patients without thyroid disease in Group-B. The age of onset, gender, Osserman classification, acetylcholine receptor antibody and thymus status of the two groups were analyzed in the two groups. Independent-sample t test was used for intra-group comparison, and χ2 test was utilized for comparison of enumeration data. P<0.05 indicates a statistically significant difference. Results: The age of onset in Group-A was significantly lower than that in Group-B (p=0.000), the number of female patients was significantly higher than that in Group-B (p=0.037), and the level of Achrabs titer was significantly lower than that in Group-B (p=0.000). The incidence of thymoma in Group-A was significantly lower than that in Group-B (p=0.012), while the incidence of thymic hyperplasia was significantly higher than that in Group-B (p=0.000). Conclusion: Patients with MG complicated with hyperthyroidism are mainly female, with a lower age of onset, a lower level of acetylcholine receptor antibody, a lower incidence of thymoma, and a higher incidence of thymic hyperplasia. The clinical features of such patients are remarkably different from those of MG without thyroid disease. doi: https://doi.org/10.12669/pjms.38.3.4656 How to cite this:Wang Y, Qi G, Yang Y. Analysis of clinical features of myasthenia gravis complicated with hyperthyroidism. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4656 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…Many studies found that MG is associated with other autoimmune diseases, particularly autoimmune thyroid diseases: Graves' disease and Hashimoto's thyroiditis. 9 Several studies demonstrated an association between the presence of thymoma with the seropositivity to AChR antibody. 10 However, to the best of our knowledge, none of these studies have investigated the association between the quantitative measurement of AChR antibody titers and the presence of thyroid autoimmune antibodies or of thymoma, particularly in OMG patients.…”

Section: Introductionmentioning

confidence: 99%

“…Autoimmune thyroid diseases are associated with MG, with Graves' disease and Hashimoto's thyroiditis as the two most common such autoimmune diseases. 9 Amin et al reported a 2.36-fold increased risk of autoimmune thyroid diseases in MG patients. 9 However, to the best of our knowledge, no reports have shown an association between AChR antibody titer and the presence of thyroid autoimmune antibodies, particularly in OMG patients.…”

mentioning

confidence: 99%

“…9 Amin et al reported a 2.36-fold increased risk of autoimmune thyroid diseases in MG patients. 9 However, to the best of our knowledge, no reports have shown an association between AChR antibody titer and the presence of thyroid autoimmune antibodies, particularly in OMG patients. We discovered that an AChR antibody titer ≥2.81 nmol/L was significantly associated with the presence of thyroid autoimmune antibodies.…”

mentioning

confidence: 99%

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Significance of Acetylcholine Receptor Antibody Titers in Acetylcholine Receptor Antibody-Positive Ocular Myasthenia Gravis: Generalization and Presence of Thyroid Autoimmune Antibodies and Thymoma

Supawongwattana¹,

Vanikieti²,

Jindahra³

et al. 2023

OPTH

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To evaluate the association in acetylcholine receptor (AChR) antibody-positive ocular myasthenia gravis (OMG) subjects between AChR antibody titers and conversion to generalized myasthenia gravis (GMG), the presence of thyroid autoimmune antibodies, and the presence of thymoma. Subjects and Methods: A total of 118 subjects with AChR antibody-positive OMG were included. Demographic data, clinical characteristics, serology tests, presence of thymoma, treatment, and conversion to GMG were retrospectively reviewed. The presence of thyroid autoimmune antibodies was defined as the presence of at least one of the following: (1) thyroid peroxidase antibody; (2) thyroglobulin antibody; (3) thyroid-stimulating hormone receptor antibody. Univariate and multivariate logistic regression analyses were used as methods of evaluating association. Results: AChR antibody titers were determined in all subjects with a median of 3.33 (0.46-141.09) nmol/L. The median follow-up period was 14.5 (3-113) months. At the final follow-up time-point, 99 subjects (83.90%) remained with a diagnosis of pure OMG, while 19 subjects (16.10%) had converted to GMG. An AChR antibody titer ≥8.11 nmol/L was associated with the conversion to GMG (odds ratio (OR) 3.66, 95% CI: 1.19-11.26; p = 0.023). Of the 79 subjects with available thyroid autoimmune antibodies data, 26 subjects (32.91%) displayed the presence of thyroid autoimmune antibodies. An AChR antibody titer ≥2.81 nmol/L was associated with the presence of thyroid autoimmune antibodies (OR 6.16,; p = 0.004). Finally, of the 106 subjects with available thoracic computed tomography (CT) data, only 9 subjects (8.49%) demonstrated the presence of thymoma. An AChR antibody titer ≥15.12 nmol/L was associated with the presence of thymoma (OR 4.97, 95% CI: 1.10-22.48; p = 0.037). Conclusion:AChR antibody titers should be considered in AChR antibody-positive OMG patients. Those with AChR antibody titers ≥8.11 nmol/L, who are at a greater risk of conversion to GMG, should be closely monitored and encouraged to be aware of early clinical signs of life-threatening GMG. In addition, serum thyroid autoimmune antibodies and thoracic CT screening for thymoma should be performed in AChR antibody-positive OMG patients, particularly in those with AChR antibody titers ≥2.81 nmol/L and ≥15.12 nmol/L, respectively.

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Myasthenia Gravis and its Association With Thyroid Diseases

Cited by 17 publications

References 34 publications

Rare concurrent ocular myasthenia gravis and Graves’ ophthalmopathy in a man with Poland syndrome: a case report

Rare concurrent ocular myasthenia gravis and Graves’ ophthalmopathy in a man with Poland syndrome: a case report

Analysis of clinical features of myasthenia gravis complicated with hyperthyroidism

Significance of Acetylcholine Receptor Antibody Titers in Acetylcholine Receptor Antibody-Positive Ocular Myasthenia Gravis: Generalization and Presence of Thyroid Autoimmune Antibodies and Thymoma

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