Abstract Details

Title Thyrotoxicosis from Graves’ Disease Presenting with Ocular Myasthenia Gravis, Thymoma, and Demyelination

Topic General Neurology

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 6-008

Objective NA

Background Graves’ disease presenting with thyrotoxicosis with simultaneous ocular myasthenia gravis with a thymoma is a rare finding but also difficult to diagnose clinically as both diseases have very specific and somewhat coinciding eye findings. This diagnosis in the setting of demyelination adds to its complexity, highlighting the importance of proper diagnosis, testing, and treatment.

Design/Methods NA

Results The patient is a 23-year-old African American male who presented with psychiatric complaints, perseveration of speech, and short-term memory loss. On exam he had decreased circumferential motion in his right eye, the inability to look medially with his left eye, tremors, hyperreflexia, and an enlarged thyroid. On further imaging, it was noted that the patient had an anterior mediastinal mass mostly likely a thymoma as well as T2 hyperintense areas in the medial longitudinal fasciculus of the brain indicating a demyelinating process. Based on the patient’s labs and unremarkable cerebrospinal fluid studies, it was determined that a prior Epstein Barr infection likely caused autoimmunity leading to Graves’ thyrotoxicosis and seronegative ocular myasthenia gravis with possible demyelination. The patient responded well to propranolol, methimazole, and pyridostigmine.

Conclusions

Graves’ disease has been linked to systemic myasthenia gravis presenting with a thymoma, however it’s exceedingly rare for it to present with ocular myasthenia gravis and demyelinating findings. The complicated clinical exam in this case somewhat masked the final diagnosis as there were many conflicting oculomotor findings. Therefore, it’s important to keep ocular myasthenia gravis on the differential in a patient with Graves’ ophthalmopathy so that it is not missed, and prompt treatment can be pursued.

Authors/Disclosures
Brittany M. Kasturiarachi, DO PRESENTER	Dr. Kasturiarachi has received personal compensation in the range of $500-$4,999 for serving as a Study Reviewer with EchoNous.
	No disclosure on file
	No disclosure on file
Muhammad F. Ishfaq, MD	Dr. Ishfaq has nothing to disclose.
	No disclosure on file