Co-existent ocular myasthenia gravis and Graves’ disease in a 5 year old
DOI:
https://doi.org/10.17161/rrnmf.v2i4.15203Abstract
Myasthenia gravis and Graves’ disease are known to co-exist in adults, yet there have only been a small number of paediatric cases reported. We report a 5 year old female who was diagnosed with ocular myasthenia gravis after presenting with unilateral ptosis and subsequently found also to have Graves’ disease. She was treated successfully with pyridostigmine, corticosteroids and carbimazole without symptom recurrence or progression to generalised myasthenia gravis. The aetiology of the coexistence is not fully understood, nor is the relationship between the two disorders’ presentation and treatment. We discuss the variation in clinical presentation of myasthenia gravis between populations and when associated with autoimmune thyroid disease, potential HLA-related genetic susceptibility and the varying approaches to treatment of the co-existent disorders.
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Koves IH, Cameron FJ, Kornberg AJ. Ocular Myasthenia Gravis and Graves Disease in a 10-year-old Child. Journal of Child Neurology. 2009;24(5):615-617. doi: 10.1177/0883073808324777
Chu HY, Shu SG, Mak SC, Chi CS. Graves' disease associated with myasthenia gravis: report of one case. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1992;33(6):457-61.
Marinó M, Ricciardi R, Pinchera A, Barbesino G, Manetti L, Chiovato L et al. Mild Clinical Expression of Myasthenia Gravis Associated with Autoimmune Thyroid Diseases. Journal of Clinical Endocrinology and Metabolism. 1997;82(2):438-443. doi: 10.1210/jcem.82.2.3749
Song R, Yao Q, Wang B, Li Q, Jia X, Zhang J. Thyroid disorders in patients with myasthenia gravis: A systematic review and meta-analysis. Autoimmunity Reviews. 2019;18(10):102368. doi: 10.1016/j.autrev.2019.102368
Ratnakorn D, Vejjajiva A. Long‐term follow‐up of myasthenia gravis patients with hyperthyroidism. Acta Neurologica Scandinavica. 2002;106(2):93-98. doi: 10.1034/j.1600-0404.2002.01191.x
Peragallo J. Pediatric Myasthenia Gravis. Seminars in Pediatric Neurology. 2017;24(2):116-121. doi: 10.1016/j.spen.2017.04.003
Mansukhani SA, Bothun ED, Diehl NN, Mohney BG. Incidence and Ocular Features of Pediatric Myasthenias. American Journal of Ophthalmology. 2019;200:242-249. doi: 10.1016/j.ajo.2019.01.004
Fisher K, Shah V. Pediatric Ocular Myasthenia Gravis. Current Treatment Options in Neurology. 2019;21(10):46. doi: 10.1007/s11940-019-0593-y
Luchanok U, Kaminski HJ. Ocular myasthenia: diagnostic and treatment recommendations and the evidence base. Current Opinion in Neurology. 2008;21(1):8-15. doi: 10.1097/WCO.0b013e3282f4098e
Vanikieti K, Lowwongngam K, Padungkiatsagul T, Visudtibhan A, Poonyathalang A. Juvenile Ocular Myasthenia Gravis: Presentation and Outcome of a Large Cohort. Pediatric Neurology. 2018;87:36-41. doi: 10.1016/j.pediatrneurol.2018.06.007
Zhang X, Yang M, Xu J, Zhang M, Lang B, Wang W et al. Clinical and serological study of myasthenia gravis in HuBei Province, China. Journal of Neurology, Neurosurgery & Psychiatry. 2007;78:386-390. doi: 10.1136/jnnp.2006.100545
Ortiz S, Borchert M. Long-term Outcomes of Pediatric Ocular Myasthenia Gravis. Ophthalmology. 2008;115(7):1245-1248. doi: 10.1016/j.ophtha.2007.10.022
Gilhus NE. Myasthenia Gravis. New England Journal of Medicine. 2016;375:2570-2581. doi: 10.1056/NEJMra1602678
Xie YC, Qu Y, Sun L, Li HF, Zhang H, Shi HJ et al. Association between HLA-DRB1 and myasthenia gravis in a northern Han Chinese population. Journal of Clinical Neuroscience. 2011;18(11):1524-1527. doi: 10.1016/j.jocn.2011.05.002
Zhong H, Zhao C, Luo S. HLA in myasthenia gravis: From superficial correlation to underlying mechanism. Autoimmunity Reviews. 2019;18(9):102349. doi: 10.1016/j.autrev.2019.102349
Léger J, Oliver I, Rodrigues D, Lambert A, Coutant R. Graves’ disease in children. Annales d’Endocrinologie. 2018;79(6):647-655. doi: 10.1016/j.ando.2018.08.001
Leger J, Carel JC. Diagnosis and management of hyperthyroidism from prenatal life to adolescence. Best Practice & Research Clinical Endocrinology & Metabolism 2018:32(4):373-386. doi: 10.1016/j.beem.2018.03.014
Srinivasan S, Misra M. Hyperthyroidism in Children. Pediatrics in Review. 2015;36(6):239-248. doi: 10.1542/pir.36-6-239
Penta L, Muzi G, Cofini M, Leonardi A, Lanciotti L, Esposito S. Corticosteroids in Moderate-to-Severe Graves’ Ophthalmopathy: Oral or Intravenous Therapy? International Journal of Environmental Research and Public Health. 2019;16(1):155. doi: 10.3390/ijerph16010155
Smith TJ, Hegedüs L. Graves’ disease. New England Journal of Medicine. 2016;375(16):1552–65. doi: 10.1056/NEJMra1510030
Sekiguchi Y, Hara Y, Takahashi M, Hirata Y. Reverse 'see-saw' relationship between Graves' disease and myasthenia gravis; clinical and immunological studies. Journal of Medical and Dental Sciences. 2005;52(1):43-50.
Ali AS, Akavaram NR. Neuromuscular disorders in thyrotoxicosis. American Family Physician. 1980;22(3):97 102.
Mallikarjuna SK, Velayutham SS, Sowmini PR, Jeyaraj MK, Arunan S. See-Saw Relationship and its Reversal after Immunotherapy in a Case of Graves' Disease with Coexisting Myasthenia Gravis. Journal of Neurosciences in Rural Practice. 2019;10(1):136-138. doi: 10.4103/jnrp.jnrp_150_18
Lee HN, Kang HC, Lee JS, Kim HD, Shin HY, Kim SM et al. Juvenile Myasthenia Gravis in Korea: Subgroup Analysis According to Sex and Onset Age. Journal of Child Neurology. 2016;31(14):1561-1568. doi: 10.1177/0883073816666206
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Copyright (c) 2021 Olivia Watson MBBS, Michelle Jack MBBS PhD FRACP, Helen Young PhD
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