Mangaraj Swayamsidha, Choudhury Arun Kumar, Mohanty Binoy Kumar, Baliarsinha Anoj Kumar
Department of Endocrinology, S. C. B Medical College, Cuttack, Odisha, India.
J Neurosci Rural Pract. 2016 Jan-Mar;7(1):153-6. doi: 10.4103/0976-3147.165393.
Graves' disease (GD) is characterized by a hyperfunctioning thyroid gland due to stimulation of the thyroid-stimulating hormone receptor by autoantibodies directed against it. Apart from thyrotoxicosis, other clinical manifestations include ophthalmopathy, dermopathy, and rarely acropachy. GD is an organ-specific autoimmune disorder, and hence is associated with various other autoimmune disorders. Myasthenia gravis (MG) is one such disease, which is seen with patients of GD and vice versa. Though the association of GD and myasthenia is known, subtle manifestations of latter can be frequently missed in routine clinical practice. The coexistence of GD and ocular MG poses a significant diagnostic dilemma to treating physicians. The ocular manifestations of myasthenia can be easily missed in case of GD and falsely attributed to thyroid associated ophthalmopathy due to closely mimicking presentations of both. Hence, a high degree of the clinical vigil is necessary in such cases to appreciate their presence. We present a similar case which exemplifies the above said that the clinical challenge in diagnosing coexistent GD and ocular myasthenia.
格雷夫斯病（GD）的特征是由于针对促甲状腺激素受体的自身抗体刺激，导致甲状腺功能亢进。除了甲状腺毒症外，其他临床表现还包括眼病、皮肤病，很少见的还有杵状指。GD是一种器官特异性自身免疫性疾病，因此与各种其他自身免疫性疾病有关。重症肌无力（MG）就是这样一种疾病，在GD患者中可见，反之亦然。虽然GD与重症肌无力的关联是已知的，但在常规临床实践中，后者的细微表现常常被遗漏。GD与眼肌型重症肌无力的共存给治疗医生带来了重大的诊断难题。在GD的情况下，重症肌无力的眼部表现很容易被遗漏，并由于两者表现相似而被错误地归因于甲状腺相关性眼病。因此，在这种情况下需要高度的临床警惕性来识别它们的存在。我们呈现了一个类似的病例，例证了上述诊断共存的GD和眼肌型重症肌无力时的临床挑战。
