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Re: Correlationship of Myasthenia and Graves Disease

Posted By CCF Neuro MD MM on October 06, 1998 at 12:11:19:

In Reply to: Correlationship of Myasthenia and Graves Disease  posted by Sharon Turner on October 06, 1998 at 06:30:24:

: I was diagnosised and treated in 1993 with radioactive iodine for Graves disease.  I also had severe upper lid retraction and went through 9 eye surgeries.  The recovery always left me with a pstosis.  My optholmologist was concerned about MG.  He gave me prednisone for my last surgery on my left eye to keep the lid from falling again during recovery.  It did fall
: and now I have my left lid slightly lower than my right.  Since the surgeries removed one of the levator muscles and the remaining muscles have been trimmed and surgically fixed with permanent stitches my lids can only be pulled down to barely closing.  I remember prior to my surgeries being able to pull my lids out and over my lower lid with lots of stretch.
Does this surgery prevent my eyes from further pstosis?  I have gradually become weaker and weaker since my diagnosis of Graves.  I have alot of difficulty with breathing.  Labored and my husband says I moan sometimes.
: It is hard for me to get up from a sitting position and I can't hardly raise my body weight to climb a latter.  My shoulders, neck and deltoids are very weak and I can't raise my arms up for very long, I also get severe pain in my neck and shoulders. My neck always feels swollen and I have a hard time swollowing pills.  I also get this cramp in my neck like a charlie horse, very painful, when I yawn or move wrong.  I lose my voice a lot and can't hardly talk.  That only happens for a month to six weeks once a year.  
I was diagnosised with FM in March of this year.  I do have the pain in the tender points but I just feel like so much more is going on. I was a personal Trainer and Fitness Instructor with my own Health Club when I was diagnoised.  I felt myself getting weaker and weaker in classes.  Now I can't exercise without exhaustion and feeling weak, dizzy and sick.
My optholmologist suggested I be tested for MG but my primary care doctor said I don't have MG because it is to rare.  The rheumatologist I just saw for the FM doesn't want to see me back until I have been tested for the MG.  Finally, someone is making sure I get tested.  
I wanted to know if these symptoms sound more like the FM or could it be MG?  I am not able to see the neuro doctor until Nov 6th and then I am sure it will still be even longer before I get tested.  Is the tennisilon test accurate?  How long does it take to get the results?  Does the injection cause pain or complications?  
I just had a CT Scan for abdominal pain and the iodine caused a severe reaction and I couldn't breathe.  I started shaking and couldn't stop for 1/2 hour and got chills.  The doctor told me to tell people I am allergic to iodine.  I didn't have any problems with iodine in 93 when they did an iodine uptake for the Graves.  Could this be a antigen problem.  I had a IgG panel done that shows 4+ positive for penicillin,> 300 and sensitivity to molds and fungus.  Could this cause an antigen problem that sets of MG.
Very concerned and off work for 2 months.  No one seems to be in any hurry except me to find out what is wrong.  I am very scarred and not sure what is happening with my health.
Thank you for your response,
Sharon Turner  

You have a number of complex inter-related problems, so I will try to answer
in the order you asked them...
1  Your eye surgery would certainly modify your ability to exhibit the
   classic signs of ptosis, it will also modify the result of the tensilon test,
   as recovery of ptosis is the usual method of seeing  aresponse, power in
   your muscles can also be used.
2  The tensilon test result shoud be obious immediately and the physician
   can give you the result on the spot.
3  The possibility of an allergy to tensilon is always possible but this is rare and
   is not related to iodine allergy, the tensilon injection is intravenous
   does not cause pain.
4  The tensilon test is not 100 % positive in all cases, it can be comlpemented
   by testing blood for antibodies and an EMG if thought necessary.
5  Overall your symptoms based on what you have related sound more like MG
   than FM
6  All allergies are due to antigen problems by definition, there is no
   evidence that a penicillen allergy would set off a subsequent MG problem.
   although people with autoimmune thyroid disease have higher rates of other immune
   diseases like MG.

You can certainly have both FM and MG, dual pathology is rare but there is
no resason it cannot occurr.
Headaches are associated with FM not MG
Antidepressants will not worsen the MG
The exhasuted feeling when your arms are held  above your head is
classically associated with MG
MG causes breathing difficulties by weakening the muscles of respiration
and double vision by weakening the muscles which move the eyes, the eyes
cannot move together as a result, and see two different images.
Moaning is not a typical of breathing difficulties.
The improvement during the Tensilon test is temporary and lasts
only a minute or so, long enough to make the diagnosis, not for
treatment, if it works a longer acting oral medication  (Mestinon) is used.
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