Wu Yi, Li Yanxi, He Weimin
Department of Ophthalmology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
Jpn J Ophthalmol. 2025 May 5. doi: 10.1007/s10384-025-01208-0.
To investigate the clinical features and prognostic factors of patients with thyroid eye disease (TED) combined with myasthenia gravis (MG) at a tertiary comprehensive hospital in China during a 10-year period.
retrospective study.
A case series of patients diagnosed with TED combined with MG was conducted at a tertiary general hospital over 10 years. Medical records of general conditions, clinical presentation, imaging and laboratory tests, treatment modalities, and prognostic outcomes were reviewed.
Twenty-three patients with TED combined with MG were found throughout the study period. The mean age was 42.57 ± 14.89 years with 10 men and 13 women. Ocular motility disorders (82.61%), diplopia (73.91%), and ptosis (73.91%) were the primary clinical manifestations, and ocular motility disorders with limited movement in all directions were common (17 eyes) (50.00%). Active (69.57%) and moderate-to-severe (82.61%) TED was common, and hyperthyroidism was the most common complication of thyroid disease (57.17%). Ocular MG was the predominant subtype of MG (86.96%). Chest CT or pathologic examination identified thymic hyperplasia in 4 patients (17.39%) and thymoma in 1 patient (4.35%). A statistically significant association was observed between smoking and an unfavorable prognosis of TED combined with MG (P<0.05).
MG should be taken into account in patients with TED who exhibit the following: unilateral or bilateral ptosis, ptosis in one eye and upper eyelid retraction in the other, obvious eye movement disorders without or with mild involvement of the extraocular muscles on imaging, and symptoms of morning and evening fluctuations. Ophthalmologists should refer these patients to the Department of Neurology to avoid misdiagnosis or underdiagnosis. The co-occurrence of TED and MG is rare clinically, mostly affecting young and middle-aged women, with ocular MG and hyperthyroidism as the main clinical subtype, and thymic hyperplasia or thymoma in a small percentage. Smoking is an independent risk factor for poor prognosis of TED combined with MG.
调查中国一家三级综合医院10年间甲状腺眼病（TED）合并重症肌无力（MG）患者的临床特征及预后因素。
回顾性研究。
在一家三级综合医院对10年间诊断为TED合并MG的患者进行病例系列研究。回顾患者的一般情况、临床表现、影像学及实验室检查、治疗方式及预后结果等病历资料。
研究期间共发现23例TED合并MG患者。平均年龄为42.57±14.89岁，男性10例，女性13例。主要临床表现为眼球运动障碍（82.61%）、复视（73.91%）和上睑下垂（73.91%），各方向运动受限的眼球运动障碍较为常见（17只眼）（50.00%）。活动期（69.57%）和中重度（82.61%）TED较为常见，甲状腺疾病最常见的并发症是甲状腺功能亢进（57.17%）。眼肌型MG是MG的主要亚型（86.96%）。胸部CT或病理检查发现4例（17.39%）胸腺增生，1例（4.35%）胸腺瘤。吸烟与TED合并MG的不良预后之间存在统计学显著关联（P<0.05）。
对于出现以下情况的TED患者应考虑合并MG：单侧或双侧上睑下垂、一眼上睑下垂另一眼上睑退缩、影像学显示明显眼球运动障碍且眼外肌无或轻度受累、有晨轻暮重症状。眼科医生应将这些患者转诊至神经内科，以避免误诊或漏诊。TED与MG临床共发少见，主要影响中青年女性，以眼肌型MG和甲状腺功能亢进为主要临床亚型，少数伴有胸腺增生或胸腺瘤。吸烟是TED合并MG预后不良的独立危险因素。
