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[Graves ophthalmopathy and ocular myasthenia]
A Widjaja1, J Rademaker, C Gölkel
1Abteilung klinische Endokrinologie und diagnostische Radiologie, Medizinische Hochschule Hannover und Department of Endocrinology, Queen Mary Hospital, Hong Kong.
Background:
An 18-year-old woman presented with thyrotoxic symptoms - right sided lid retraction and exophthalmus. She complained of diplopia on lateral gaze. Laboratory investigations confirmed Grave's disease with hyperthyroidism and TSH receptor antibodies.
Patients And Methods:
Her clinical symptoms improved after thyrostatic and steroid therapy. However, diplopia recurred 2 weeks after withdrawal of steroid therapy and a ptosis of the left lid appeared for the first time.
Results:
A positive Tensilon test and electromyographic findings confirmed the diagnosis of myasthenia gravis with a predominantly ocular manifestation. Diplopia and ptosis improved with oral pyridostigmine.
Conclusions:
The coexistence of myasthenia gravis should be taken into consideration in the management of patients with Graves' ophthalmopathy.