Osher R H, Smith J L
Am J Ophthalmol. 1975 Jun;79(6):1038-43. doi: 10.1016/0002-9394(75)90691-1.
Two patients had ocular myasthenia gravis coexistent with Hashimoto's thyroiditis. A 37-year-old woman presented with diplopia and displayed a head tremor and thyroid enlargement. Thyroid function tests showed an elevated thyroid stimulating hormone (TSH). A quantitative Tensilon test yeilded a "perverse" response and a needle biopsy indicated Hashimoto's disease. A 26-year-old woman presented with diplopia and subsequently developed blepharoptosis and thyroid enlargement. Examination revealed Cogan's eyelid twitch sign, a paradoxical quantitative Tensilon test, and laboratory studies revealed normal thyroid function tests. Treatment was directed at each disease entity separately. Ocular myasthenia gravis was managed with an anticholinesterase agent in combination with oral corticosteroids that provided additional control. Suppressive therapy with desiccated thyroid hormone reduced the size of the thyroid gland, diminished the signs and symptoms of hypothyroidism, and lowered the levels of TSH, possibly decreasing the risk of thyroid carcinoma. Both patients showed gratifying responses to therapy.
两名患者同时患有眼肌型重症肌无力和桥本甲状腺炎。一名37岁女性出现复视，伴有头部震颤和甲状腺肿大。甲状腺功能检查显示促甲状腺激素（TSH）升高。定量腾喜龙试验呈“反常”反应，针吸活检提示为桥本氏病。一名26岁女性出现复视，随后发展为上睑下垂和甲状腺肿大。检查发现有科根眼睑抽搐征、反常定量腾喜龙试验，实验室检查甲状腺功能正常。针对每种疾病分别进行治疗。眼肌型重症肌无力采用抗胆碱酯酶药物联合口服皮质类固醇治疗，后者可提供额外的控制效果。用干燥甲状腺激素进行抑制治疗缩小了甲状腺的大小，减轻了甲状腺功能减退的体征和症状，降低了TSH水平，可能降低了甲状腺癌的风险。两名患者对治疗均有满意的反应。
