MYASTHENIA GRAVIS AND HYPERTHYROIDISM: REPORT OF TWO CASES AND REVIEW OF THE LITERATURE
Authors: G D WEICKHARDT, A J REDMOND
Journal: Annals of Internal Medicine (1960)

Article1 June 1960MYASTHENIA GRAVIS AND HYPERTHYROIDISM: REPORT OF TWO CASES AND REVIEW OF THE LITERATUREGEORGE D. WEICKHARDT, M.D., F.A.C.P., ARTHUR J. REDMOND, M.D.GEORGE D. WEICKHARDT, M.D., F.A.C.P.Search for more papers by this author, ARTHUR J. REDMOND, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-52-6-1246 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough the concurrence of myasthenia gravis and hyperthyroidism is not rare, it is uncommon enough to warrant additional case reports. A review of the literature indicates that 82 cases1-36 have been reported in which there is little doubt of the validity of the existence of these diseases in the same patient, although not always contemporaneously. (The 24 articles cited by Shafer and Allen35 appear to contain 63 cases, rather than 85, as reported.) Cases mentioned by Dudgeon and Urquhart,47 Miller,37 Moore,38 Ringertz,39 Levitt40 and Rowland and his co-workers41 do not contain detailed clinical histories.Two additional cases are herewith reported....Bibliography1. Meyerstein R: Ueber das kombinierte Vorkommen von Myasthenie und Basedow'scher Krankheit, Neurol. Centralbl. 23: 1089-1092, 1904. Google Scholar2. Loeser : Über das kombinierte Vorkommen von Myasthenie und Basedow'scher Krankheit, nebst Bemerkungen über die okulären Symptome der Myasthenie, Ztschr. f. Augenh. 12: 368-375, 1904. Google Scholar3. Rennie GE: Exophthalmic goitre combined with myasthenia gravis, M. J. Australia 2: 416-417 (Nov. 15) 1919. CrossrefGoogle Scholar4. SchumacherRoth : Thymektomie bei einem Fall von Morbus Basedowi mit Myasthenie, Mitt. a. d. Grenzgeb. d. Med. u. Chir. 25: 746-765, 1913. Google Scholar5. Rennie GE: Myasthenia gravis with exophthalmic goitre, Rev. Neurol. and Psychiat. 11: 475-478, 1913. Google Scholar6. Vedsmand H: Myasthenia gravis, Mb. Basedowii, Ugesk. f. læger 85: 405-407 (June 7) 1923. Google Scholar7. WolffKeutmannCobb HGHS: The electromyogram in myasthenia gravis, Brain 51: 508-519 (Dec.) 1928. CrossrefGoogle Scholar8. CohenKing SJFH: Relation between myasthenia gravis and exophthalmic goiter, Arch. Neurol. and Psychiat. 28: 1338-1345 (Dec.) 1932. CrossrefGoogle Scholar9. Allan FN: Muscular weakness and hyperthyroidism, myasthenia gravis and goiter, S. Clin. North America 14: 1249-1255 (Oct.) 1934. Google Scholar10. Fraser FR: Exophthalmic ophthalmoplegia: effect of Prostigmin in two cases, Tr. Ophth. Soc. U. Kingdom 57: 116-118, 1937. Google Scholar11. Schönberg H: Grenzfall von Morbus Basedowii und Myasthenia gravis pseudoparalytica, Deutsche med. Wchnschr. 63: 738-741 (May 7) 1937. CrossrefGoogle Scholar12. Zondek H: Adanamischer Basedow, Schweiz. med. Wchnschr. 68: 65-68 (Jan. 15) 1938. Google Scholar13. Adler H: Myasthenie, Basedow und Thymusfunktion, Deutsche med. Wchnschr. 65: 909 (June 9) 1939. CrossrefGoogle Scholar14. Thorner MW: Relation of myasthenia gravis to hyperthyroidism, Arch. Int. Med. 64: 330-335 (Aug.) 1939. CrossrefGoogle Scholar15. Van Bogaert L: Sur l'antagonisme de la myasthenie et de la thyreotoxicose, Schweiz. med. Wchnschr. 70: 501-502 (June 8) 1940. Google Scholar16. WolpersArnold CO: Zur intravenösen Dijodtyrosinbehandlung Basedow- und Thyreotoxikose-Kranker in kritischen Krankheitsstadien, Deutsche. med. Wchnschr. 67: 5-9 (Jan. 3) 1941. CrossrefGoogle Scholar17. KowallisHainesPemberton GFSFJ: Goiter with associated myasthenia gravis, Arch. Int. Med. 69: 41-50 (Jan.) 1942. CrossrefGoogle Scholar18. Carson J: Discussion on myasthenia gravis and thymectomy, Proc. Roy. Soc. Med. 36: 140-144 (Jan.) 1943. CrossrefMedlineGoogle Scholar19. Laurent LP: Acute thyrotoxic bulbar palsy, Lancet 1: 87-88 (Jan. 15) 1944. CrossrefGoogle Scholar20. Flynn R: Graves' disease with disassociation of thyreotoxicosis and ophthalmopathy associated with myasthenia gravis, M. J. Australia 1: 344-346 (Apr. 15) 1944. CrossrefGoogle Scholar21. Cohen B: Thyrotoxicosis by myasthenia gravis, South African M. J. 20: 408-410 (July 27) 1946. MedlineGoogle Scholar22. SheldonWalker JHRM: Acute thyrotoxic myopathy, Lancet 1: 342-343 (Mar. 9) 1946. CrossrefMedlineGoogle Scholar23. ThornEder GWHA: Studies on chronic thyrotoxic myopathy, Am. J. Med. 1: 583-601 (Dec.) 1946. CrossrefMedlineGoogle Scholar24. McEachernParnell DJL: The relationship of hyperthyroidism to myasthenia gravis, J. Clin. Endocrinol. 8: 842-850 (Oct.) 1948. CrossrefGoogle Scholar25. BartelsKingsley ECJW: Hyperthyroidism associated with myasthenia gravis, Lahey Clin. Bull. 6: 101-108 (Apr.) 1949. MedlineGoogle Scholar26. Greene R: Thyrotoxicosis, exophthalmic ophthalmoplegia, myasthenia gravis and vitiligo, Proc. Roy. Soc. Med. 27: 263-267 (Apr.) 1949. CrossrefGoogle Scholar27. LevyMeadowsGunnar GWRRM: The association of Graves' disease with myasthenia gravis, with a report of five cases, Ann. Int. Med. 35: 134-147 (July) 1951. LinkGoogle Scholar28. ZondekTicho HA: Myasthenia gravis and malignant exophthalmos, Lancet 2: 1018-1020 (Dec. 1) 1951. CrossrefMedlineGoogle Scholar29. TaylorLarge NA: Myasthenia gravis associated with hyperthyroidism: report of a case with thymectomy, Am. J. M. Sc. 221: 293-296 (Mar.) 1951. CrossrefMedlineGoogle Scholar30. MillikanHaines CHSF: The thyroid gland in relation to neuromuscular disease, Arch. Int. Med. 92: 5-39 (July) 1953. CrossrefGoogle Scholar31. AlthoffFloer HI: Zur Myasthenia gravis pseudoparalytica im Kindesalter und über ihre Kombination mit der Basedowschen Erkrankung, Deutsche med. Wchnschr. 78: 1262-1264 (Sept. 11) 1953. CrossrefMedlineGoogle Scholar32. GrobHarvey DAM: Abnormalities in neuromuscular transmission with special reference to myasthenia gravis, Am. J. Med. 15: 695-709 (Nov.) 1953. CrossrefMedlineGoogle Scholar33. MacleanWilson BJA: See-saw relationship between hyperthyroidism and myasthenia gravis, Lancet 1: 950-953 (May 8) 1954. CrossrefGoogle Scholar34. PrasadLevi RJE: Thyrotoxic myopathy and myasthenia gravis, J. Clin. Endocrinol. and Metabolism 15: 476-480 (Apr.) 1955. CrossrefGoogle Scholar35. ShaferAllen AMS: Hyperthyroidism and myasthenia gravis, Kansas M. Soc. J. 58: 169-174 (Mar.) 1957. MedlineGoogle Scholar36. SilverOsserman SKE: Hyperthyroidism and myasthenia gravis, J. Mt. Sinai Hosp. 24: 1214-1220 (Nov.) 1957. MedlineGoogle Scholar37. Miller HG: Myasthenia gravis and the thymus gland, Arch. Path. 29: 212-219 (Feb.) 1940. Google Scholar38. Moore FD: Toxic manifestations of thiouracil therapy, J. A. M. A. 130: 315-319 (Feb. 9) 1946. CrossrefMedlineGoogle Scholar39. Ringertz N: Pathology of the thymus and other organs in myasthenia gravis, Acta path. et microbiol. Scandinav. 29: 9-25, 1951. CrossrefMedlineGoogle Scholar40. Levitt T: The thyroid, a physiological, pathological, clinical and surgical study, 1954, The Williams and Wilkins Co., Baltimore. Google Scholar41. RowlandHoeferAranowMerritt LPPFHHH: Fatalities in myasthenia gravis, a review of 39 cases with 26 autopsies, Neurology 6: 307-326 (May) 1956. CrossrefMedlineGoogle Scholar42. Hatch HA: Myasthenia gravis: report of a case with exophthalmos, without hyperthyroidism, relieved by neostigmine, New England J. Med. 246: 856-858 (May 29) 1952. CrossrefMedlineGoogle Scholar43. JacksonBates ASAD: Myasthenia gravis, J. A. M. A. 81: 114 (July 14) 1923. CrossrefGoogle Scholar44. BryanMcDonaldClagett ALJROT: Comparison of thymic hyperplasia in myasthenia gravis and exophthalmic goiter, Arch. Path. 46: 212-228 (Sept.) 1948. Google Scholar45. GiordanoHaymond ASJL: Myasthenia gravis: a report of two cases with necropsy findings, Am. J. Clin. Path. 14: 253-265 (May) 1944. CrossrefGoogle Scholar46. Milhorat AT: Studies in diseases of muscle, Arch. Neurol. and Psychiat. 46: 800-834 (Nov.) 1941. CrossrefGoogle Scholar47. DudgeonUrquhart LSAL: Lymphorrhages in the muscles in exophthalmic goitre, Brain 29: 182-186 (June) 1926. CrossrefGoogle Scholar48. Waldenström J: Acute thyrotoxic encephalo- or myopathy, its cause and treatment, Acta med. scandinav. 121: 251-294, 1945. CrossrefGoogle Scholar49. McEachernRoss DWD: Chronic thyrotoxic myopathy, Brain 65: 181-192 (June) 1942. CrossrefGoogle Scholar50. Walker MB: Case showing effect of prostigmin on myasthenia gravis, Proc. Roy. Soc. Med. 28: 759-761 (Apr.) 1935. CrossrefMedlineGoogle Scholar51. Jolly F: Ueber Myasthenia gravis pseudoparalytica, Berl. med. Gesellsch. Verhandl. 25: 229-249, 1894. Google Scholar52. Warner F: Ophthalmoplegia externa complicating Graves' disease, M. Times and Gaz. 2: 541 (Oct. 18) 1882. Google Scholar53. Bristowe JS: Cases of ophthalmoplegia complicated with various other affections of the nervous system, Brain 8: 313-344, 1885-86. CrossrefGoogle Scholar54. Jendrassik E: Vom Verhältnisse der Poliomyelencephalitis zur Basedow'schen Krankheit, Arch. f. Psychiat. 17: 301-321, 1886. CrossrefGoogle Scholar55. Ballet G: Paralysies des nerfs moteurs bulbaires dans le goître exophthalmique, Gaz. hebd. de méd. 25: 132-134, 1888. Google Scholar56. Maude A: A case of ophthalmoplegia with Graves' disease, Brain 15: 121-123, 1892. CrossrefGoogle Scholar57. Von Müller F: Beiträge zur Kenntnis der Basedow'schen Krankheit, Deutsches Arch. f. klin. Med. 51: 335-412, 1892-1893. Google Scholar58. Voss G: Zur Symptomatologie und Therapie der Basedow'schen Krankheit, Deutsche med. Wchnschr. 29: 590-591 (Aug. 13) 1903. CrossrefGoogle Scholar59. Posey WC: Palsy of the extraocular muscles in exophthalmic goitre, Am. J. M. Sc. 128: 66-72 (July) 1904. CrossrefGoogle Scholar60. WeddPermar AMHH: Ophthalmoplegia in Graves' disease, Am. J. M. Sc. 175: 733-740 (June) 1928. CrossrefGoogle Scholar61. Burger W: Ueber Thyrotoxikose mit spinalen Symptomen, Deutsches Arch. f. klin. Med. 162: 355-357 (Dec.) 1928. Google Scholar62. Garvey JL: Ophthalmoplegia and Graves' disease, Ann. Int. Med. 3: 917-919 (Mar.) 1930. LinkGoogle Scholar63. Heuer GJ: The cerebral nerve disturbances in exophthalmic goitre, Am. J. M. Sc. 151: 339-351 (Mar.) 1916. CrossrefGoogle Scholar64. Oppenheim H: Die myasthenische Paralyse, 1901, S. Karger, Berlin. Google Scholar65. Kappis M: Ueber Gehirnnervenlähmungen bei der Basedow'schen Krankheit, Mitt. a. d. Grenzgeb. d. Med. u. Chir. 22: 657-674, 1911. Google Scholar66. Rennie GE: Myasthenia gravis, Australasian M. Gaz. 23: 205-209 (May 20) 1904. Google Scholar67. BrissaudBauer : Syndrome de Basedow associé à une paralysie bulbo-spinale asthénique, Rev. Neurol., Paris 12: 1224-1226, 1904. Google Scholar68. Sterling W: Maladie de Basedow, myasthénie et amyotrophie progressive, Rev. neurol. 1: 93-94 (Jan.) 1930. Google Scholar69. Rennie GE: Exophthalmic goitre combined with myasthenia gravis, Rev. Neurol. and Psychiat. 6: 229-233, 1908. Google Scholar70. McKendree CA: A case of myasthenia gravis, J. A. M. A. 63: 1553-1555 (Oct. 31) 1914. CrossrefGoogle Scholar71. Kane CA: The effect of certain endocrine glands on myasthenia gravis, Am. J. Med. 19: 729-733 (Nov.) 1955. CrossrefMedlineGoogle Scholar72. Nevin S: Primary diseases of voluntary muscles, J. Neurol. and Psychiat. 1: 120-141 (Apr.) 1938. CrossrefGoogle Scholar73. Eaton LM: Myasthenia gravis: its treatment and relation to the thymus, Proc. Staff Meet., Mayo Clin. 17: 81-87 (Feb. 11) 1942. Google Scholar74. BlalockHarveyFordLilienthal AAMFRJL: The treatment of myasthenia gravis by removal of the thymus gland, J. A. M. A. 117: 1529-1533 (Nov. 1) 1941. CrossrefGoogle Scholar75. Norris EH: The thymoma and thymic hyperplasia in myasthenia gravis with observations on the general pathology, Am. J. Cancer 27: 421-433 (July) 1936. CrossrefGoogle Scholar76. RemakSattler H: Basedow's disease, English translation by G. W. and J. F. Marchand, 1952, Grune and Stratton, New York, p. 163. Google Scholar77. BarlaroCasullo PMCA: Oftalmoplejía en el curso de la enfermedad de Basedow, Prensa méd. argent. 27: 878-885 (April 24) 1940. Google Scholar78. Goñi AR: Myasthenia gravis, translated by G. S. Gittinger, 1946, The Williams and Wilkins Co., Baltimore, p. 16. Google Scholar79. Klien H: Über die Bedeutung der bei Morbus Basedowii nachgewiesenen pathologischanatomischen Befunde, Deutsche Ztschr. f. Nervenh. 25: 431-455, 1903-04. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *Received for publication December 28, 1959.Requests for reprints should be addressed to George D. Weickhardt, M.D., 2025 Eye Street, N. W., Washington 6, D. C. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byGraves' DiseaseThyroid DisordersMyasthenia gravis: Overlap with ?polyendocrine? autoimmunityHyperthyroidism. Causes, etiology of Graves’ disease, clinical features, general aspects of treatmentA Case Report of Myasthenia Gravis Coexistent with Thymic Tumor and HyperthyroidismEndokrinologie in der KinderheilkundeThyrotoxic crisis and transient myasthenia gravis in pregnancy.Differential Diagnosis of Muscle Weakness in Myasthenia Gravis, Polymyositis and Muscular DystrophyAcute Tubular Necrosis Consequent to Encephalomyopathic Thyroid CrisisMyasthenia Gravis and the Thyroid Gland 1 June 1960Volume 52, Issue 6Page: 1246-1257KeywordsHyperthyroidismMyasthenia gravisThyroid Issue Published: 1 June 1960 PDF downloadLoading ...