Dual attack: targeting the rare co-occurrence of myasthenia gravis and Graves’ disease with radioactive iodine therapy

Occasionally, autoimmune disorders can come in twos. This double trouble creates unique challenges. Myasthenia gravis co-existing with autoimmune thyroid disease occurs in only about 0.14–0.2% of cases. The patient is a 27-year-old man with a 2-month history of bilateral ptosis, diplopia, with episo...

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Main Authors:	Anna Elvira S Arcellana, Karen Joy B Adiao, Myrna Buenaluz-Sedurante
Format:	Article
Language:	English
Published:	Bioscientifica 2021-07-01
Series:	Endocrinology, Diabetes & Metabolism Case Reports
Online Access:	https://edm.bioscientifica.com/view/journals/edm/2021/1/EDM21-0046.xml

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spelling	doaj-ce08445c409d4268a587860e805a3c5a2021-07-03T05:25:39ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732052-05732021-07-01111510.1530/EDM-21-0046Dual attack: targeting the rare co-occurrence of myasthenia gravis and Graves’ disease with radioactive iodine therapyAnna Elvira S Arcellana0Karen Joy B Adiao1Myrna Buenaluz-Sedurante2Division of Endocrinology, Diabetes and Metabolism, Department of MedicineDepartment of Neurosciences, University of the Philippines-Manila, Philippine General Hospital, Manila, PhilippinesDivision of Endocrinology, Diabetes and Metabolism, Department of MedicineOccasionally, autoimmune disorders can come in twos. This double trouble creates unique challenges. Myasthenia gravis co-existing with autoimmune thyroid disease occurs in only about 0.14–0.2% of cases. The patient is a 27-year-old man with a 2-month history of bilateral ptosis, diplopia, with episodes of easy fatigability, palpitations, and heat intolerance. On physical exam, the patient had an enlarged thyroid gland. Myasthenia gravis was established based on the presence of ptosis with weakness of the intraocular muscles, abnormal fatigability, and a repetitive nerve stimulation study indicated neuromuscular junction disease. Episodes of fluctuating right shoulder weakness were also noted. He was also found to have elevated FT3, FT4, and a suppressed TSH. Thyroid ultrasound revealed thyromegaly with diffused parenchymal disease. Thyroid scintigraphy showed increased uptake function at 72.4% uptake at 24 h. TRAb was positive at 4.1 U/L. Patient was started on pyridostigmine which led to a significant reduction in the frequency of ocular muscle weakness. Methimazole was also initiated. Radioactive iodine at 14.9 mci was instituted for the definitive management of hyperthyroidism. After RAI, there was abatement of the hyperthyroid symptoms, as well as improvement in the status of the myasthenia gravis, with ptosis, diplopia, and right arm weakness hardly occurring thereafter despite the reduction of the pyridostigmine dose based on a symptom diary and medication intake record. Two distinct autoimmune conditions displayed a markedly improved clinical course with the institution of radioactive iodine therapy for Graves’ disease.https://edm.bioscientifica.com/view/journals/edm/2021/1/EDM21-0046.xml
collection	DOAJ
language	English
format	Article
sources	DOAJ
author	Anna Elvira S Arcellana Karen Joy B Adiao Myrna Buenaluz-Sedurante
spellingShingle	Anna Elvira S Arcellana Karen Joy B Adiao Myrna Buenaluz-Sedurante Dual attack: targeting the rare co-occurrence of myasthenia gravis and Graves’ disease with radioactive iodine therapy Endocrinology, Diabetes & Metabolism Case Reports
author_facet	Anna Elvira S Arcellana Karen Joy B Adiao Myrna Buenaluz-Sedurante
author_sort	Anna Elvira S Arcellana
title	Dual attack: targeting the rare co-occurrence of myasthenia gravis and Graves’ disease with radioactive iodine therapy
title_short	Dual attack: targeting the rare co-occurrence of myasthenia gravis and Graves’ disease with radioactive iodine therapy
title_full	Dual attack: targeting the rare co-occurrence of myasthenia gravis and Graves’ disease with radioactive iodine therapy
title_fullStr	Dual attack: targeting the rare co-occurrence of myasthenia gravis and Graves’ disease with radioactive iodine therapy
title_full_unstemmed	Dual attack: targeting the rare co-occurrence of myasthenia gravis and Graves’ disease with radioactive iodine therapy
title_sort	dual attack: targeting the rare co-occurrence of myasthenia gravis and graves’ disease with radioactive iodine therapy
publisher	Bioscientifica
series	Endocrinology, Diabetes & Metabolism Case Reports
issn	2052-0573 2052-0573
publishDate	2021-07-01
description	Occasionally, autoimmune disorders can come in twos. This double trouble creates unique challenges. Myasthenia gravis co-existing with autoimmune thyroid disease occurs in only about 0.14–0.2% of cases. The patient is a 27-year-old man with a 2-month history of bilateral ptosis, diplopia, with episodes of easy fatigability, palpitations, and heat intolerance. On physical exam, the patient had an enlarged thyroid gland. Myasthenia gravis was established based on the presence of ptosis with weakness of the intraocular muscles, abnormal fatigability, and a repetitive nerve stimulation study indicated neuromuscular junction disease. Episodes of fluctuating right shoulder weakness were also noted. He was also found to have elevated FT3, FT4, and a suppressed TSH. Thyroid ultrasound revealed thyromegaly with diffused parenchymal disease. Thyroid scintigraphy showed increased uptake function at 72.4% uptake at 24 h. TRAb was positive at 4.1 U/L. Patient was started on pyridostigmine which led to a significant reduction in the frequency of ocular muscle weakness. Methimazole was also initiated. Radioactive iodine at 14.9 mci was instituted for the definitive management of hyperthyroidism. After RAI, there was abatement of the hyperthyroid symptoms, as well as improvement in the status of the myasthenia gravis, with ptosis, diplopia, and right arm weakness hardly occurring thereafter despite the reduction of the pyridostigmine dose based on a symptom diary and medication intake record. Two distinct autoimmune conditions displayed a markedly improved clinical course with the institution of radioactive iodine therapy for Graves’ disease.
url	https://edm.bioscientifica.com/view/journals/edm/2021/1/EDM21-0046.xml
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Dual attack: targeting the rare co-occurrence of myasthenia gravis and Graves’ disease with radioactive iodine therapy

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