We describe an 80 year-old man with Graves thyrotoxicosis and thyroid orbitoapthy accompanied by ocular myasthenia gravis.
He presented in 2004 with chemosis, exophthalmos, diplopia, ptosis, and restricted movements. He also gave history of weight loss (six kilograms). FT4 29, FT3 7.7 and TSH 0.04. MRI Orbits revealed swelling of the extra-ocular muscles.
Ocular movement was markedly restricted but a curious feature of the presentation was bilateral partial ptosis raised the possibility of coincidental ocular myasthenia gravis. This was been confirmed by positive acetylcholine receptor antibodies. There were no extra-ocular features of myasthenia gravis.
His hyperthyroidism has been controlled with a block and replace regimen using Carbimazole and Thyroxine. His diplopia and ptosis responded fairly well to prednisolone and pyridostigmine. He remains under follow up.
The simulataneous presentation of Graves ophthalmopathy and ocular myasthenia is rare and infrequently reported. We review the existing literature and look at current management options.