Ocular myasthenia gravis presenting with Graves disease - a case report

The coexistence of Graves disease and myasthenia gravis - two distinct autoimmune disorders directed against membrane receptors TSH R and Ach R respectively has been well documented. We are reporting a case of Ossermans grade I restricted ocular myasthenia gravis presenting with Graves disease with an aim to review literature on the optimal management of these two coexisting disorders. A 38 year old man presented with ptosis about a year after the onset of Graves disease. He was diagnosed to have ocular myasthenia as he tested positive for Ach R Ab. He was managed with antithyroid drugs, cholinesterase inhibitors, and steroid. After attaining euthyroidism a total thyroidectomy with extended trans-sternal thymectomy was performed. He was relieved of his ocular symptoms. Ptosis in a patient with Graves disease should prompt one to investigate for myasthenia gravis. Surgery done for both the disorders at the same sitting has a favourable outcome.