An Interesting case of Grave’s Disease and Myasthenia Gravis

Abstract

Presentation of Grave’s disease and Myathenia Gravis together is rare but well known. Both are autoimmune diseases and have ocular manifestations. The patients suffering from one autoimmune disease is at a higher risk of developing other autoimmune diseases as well and multiple reasons are documented for this including cross-reactivity of antibodies with auto antigens, genetic predisposition. When fully expressed, Graves' disease causes thyrotoxicosis, goitre, exophthalmos, and pretibial myxedema, but it can also cause one or more of these symptoms. The abnormal immune response is marked by the presence of antibodies directed against thyroid tissue antigens, including antibodies that bind to the thyrotrophin receptor. In active Graves' disease, some of these antibodies act as agonists and activate the thyroid, causing T-lymphocyte suppressor cell activity to be decreased and suppressor cell population to be reduced. Graves' disease is thought to be caused by a defect in the regulation of autoimmune reactions, which leads to the creation of excessive amounts of autoantibodies, which may stimulate the thyroid or finally cause thyroid damage and cell death. The thyroid gland is hyperfunctioning in Graves' disease. Also inhibited is the pituitary response to TRH. Small dosages of iodide, which simultaneously prevent future hormone production and limit hormone release from the gland, have an extremely strong effect on the gland.

Case:  A 36 years old young male presented with classical symptoms of hyperthyroidism many of which were relieved after starting treatment but muscular weakness persisted hence on further investigations Myathenia Gravis was also diagnosed.

AIM: An Interesting Case of Grave’s Disease and Myasthenia Gravis

CONCLUSION: Awareness about possibility of concurrent existence of both illnesses can clinch accurate diagnosis which has important implications in treatment.