Raef H, Ladinsky M, Arem R
Division of Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX 77030.
Postgrad Med J. 1990 Oct;66(780):849-52. doi: 10.1136/pgmj.66.780.849.
A 44 year old diabetic woman presented with diplopia and bilateral ptosis and mild exophthalmos. The patient was clinically euthyroid, the baseline thyroid function tests were normal, but the thyroid stimulating hormone response to thyrotrophin releasing hormone was flat. Computed tomographic scan and magnetic resonance imaging of the orbits showed left medial and inferior rectus muscle thickening, more prominent on the left side, consistent with Graves' disease. The tensilon stimulation test resulted in resolution of the ptosis and partial improvement of the ophthalmoplegia. The single fibre electromyography was consistent with a defect in neuromuscular transmission. However, forced duction test was normal and anti-acetylcholine receptor antibodies were undetectable. Significant improvement of the extraocular muscle function and resolution of the right ptosis had resulted from anticholinesterase therapy. These findings and the clinical response to therapy were consistent with concomitant euthyroid Graves' ophthalmopathy and ocular myasthenia gravis. Coexistent isolated ocular myasthenia gravis and Graves' ophthalmopathy is rare and should be considered in patients with findings of ocular myasthenia and extraocular muscle dysfunction.
一名44岁的糖尿病女性出现复视、双侧上睑下垂和轻度突眼。患者临床甲状腺功能正常，基线甲状腺功能检查正常，但促甲状腺激素对促甲状腺素释放激素的反应呈平坦状态。眼眶计算机断层扫描和磁共振成像显示左侧内直肌和下直肌增厚，左侧更明显，符合格雷夫斯病。腾喜龙刺激试验使上睑下垂消失，眼肌麻痹部分改善。单纤维肌电图与神经肌肉传递缺陷一致。然而，强迫牵拉试验正常，未检测到抗乙酰胆碱受体抗体。抗胆碱酯酶治疗使眼外肌功能显著改善，右侧上睑下垂消失。这些发现以及对治疗的临床反应与伴发的甲状腺功能正常的格雷夫斯眼病和眼型重症肌无力相符。孤立性眼型重症肌无力和格雷夫斯眼病并存罕见，对于有眼型重症肌无力和眼外肌功能障碍表现的患者应予以考虑。
