Myasthenia Gravis with Toxic Goiter: Challenges with Management in a Low-Resource Setting in Africa; Review of Literature and Case Report.
Journal
Nigerian journal of clinical practice
ISSN: 1119-3077
Titre abrégé: Niger J Clin Pract
Pays: India
ID NLM: 101150032
Informations de publication
Date de publication:
01 Jan 2024
01 Jan 2024
Historique:
received:
22
03
2023
accepted:
04
12
2023
medline:
6
2
2024
pubmed:
6
2
2024
entrez:
5
2
2024
Statut:
ppublish
Résumé
Myasthenia gravis (MG) is an antibody-mediated autoimmune disease with the cardinal feature being exertional voluntary skeletal muscle weakness and fatigability. It can be an isolated finding or in association with other autoimmune conditions such as Hashimoto's thyroiditis, Graves' disease, systemic lupus erythematosus (SLE), or rheumatoid arthritis. Thymectomy is recommended for most patients with MG whose symptoms begin before the age of 60 years. Patients with thymoma or thymic hyperplasia do respond to thymectomy compared to those without thymoma or enlarged thymus. Those with enlarged goiter would benefit from thyroidectomy. The management of these patients requires a multidisciplinary approach as performed in a low-resource setting. We are reporting the case of a 24-year-old who presented with MG with toxic goiter and had good control on medication. A computed tomography scan of the chest showed a superior mediastinal mass and a soft tissue scan of the neck was done which showed a diffusely enlarged thyroid gland. She subsequently had thymectomy and subtotal thyroidectomy with a satisfactory outcome. We highlight this case to show that MG with thymoma and goiter could coexist. Reports of such findings are infrequently reported in our environment.
Identifiants
pubmed: 38317049
doi: 10.4103/njcp.njcp_206_23
pii: 01253091-202401000-00022
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
148-152Informations de copyright
Copyright © 2024 Copyright: © 2024 Nigerian Journal of Clinical Practice.
Références
Okeafor CU, Awoyesuku EA. Differential diagnosis of myasthenia gravis:A review. Yen Med J 2020;2:5–14.
Selmi C. Hot topics in autoimmune diseases:Perspectives from the 2013 Asian Congress of Autoimmunity. Autoimmun Rev 2014;13:781–7.
Pouye A, Dia DG, Ndongo S, Faye A, Sakho ND, Ndiaye FSD. Grave's disease associated with myasthenia gravis:A case report. Intern Med Inside 2014;2:4. http://dx.doi.org/10.7243/2052-6954-2-4.
doi: 10.7243/2052-6954-2-4
Toyka KV, Brachman DB, Pestronk A, Kao I. Myasthenia gravis:Passive transfer from man to mouse. Science 1975;190:397–9.
Dresser L, Wlodarski R, Rezania K, Soliven B. Myasthenia gravis:Epidemiology, pathophysiology and clinical manifestations. J Clin Med 2021;10:2235. doi:10.3390/jcm10112235.
doi: 10.3390/jcm10112235
Behbehani R. Ocular myasthenia gravis:A current overview. Eye Brain 2023;15:1–13.
Kucharczuk JC, Cooper JD. Transcervical thymectomy for nonthymomatous myasthenia gravis. Pearsons Thoracic and Esophageal Surgery, 2:3rded, Churchill Living Stone 2008;2:1715–19.
Berrouschot J, Baumann I, Kalischewski P, Sterker M, Schneider D. Therapy of myasthenic crisis. Crit Care Med 1997;25:1228–35.
Grob D, Brunner N, Namba T, Pagala M. Lifetime course of myasthenia gravis. Muscle Nerve 2008;37:141–9.
Chou CC, Huang MH, Lan WC, Kong SS, Kuo CF, Chou IJ. Prevalence and risk of thyroid diseases in myasthenia gravis. Acta Neurol Scand 2020;142:239–47.
Chen YP, Wei DN, Chen B. [The clinical features of myasthenia gravis associated with thyroid abnormalities. Zhonghua Nei Ke Za Zhi 2010;49:602–5.
Toth C, McDonald D, Oger J, Brownell K. Acetylcholine receptor antibodies in myasthenia gravis are associated with greater risk of diabetes and thyroid disease. Acta Neurol Scand 2006;114:124–32.
Vincent A, Palace J, Hilton-Jones D. Myasthenia gravis. Lancet 2001;357:2122–8.
Lakhal K, Blel Y, Fysekidis M, Mohammedi K, Bouadma L. Concurrent graves disease thyrotoxicosis and myasthenia gravis:The treatment of the former may dangerously reveal the latter. Anaesthesia 2008;63:876–9.
Kung AW. Neuromuscular complications of thyrotoxicosis. Clin Endocrinol (Oxf) 2007;67:645–50.
Kung AW. Clinical review:Thyrotoxic periodic paralysis:A diagnostic challenge. J Clin Endocrinol Metab 2006;91:2490–5.
Amin S, Aung M, Gandhi FR, Pena Escobar JA, Gulraiz A, Malik BH. Myasthenia gravis and its association with thyroid diseases. Cureus 2020;12:e10248. doi:10.7759/cureus.10248.
doi: 10.7759/cureus.10248
García-Carrasco M, Escárcega RO, Fuentes-Alexandro S, Riebeling C, Cervera R. Therapeutic options in autoimmune myasthenia gravis. Autoimmun Rev 2007;6:373–8. 10.1016/j.autrev.2007.01.001.
doi: 10.1016/j.autrev.2007.01.001
Farmakidis C, Pasnoor M, Dimachkie MM, Barohn RJ. Treatment of myasthenia gravis. Neurol Clin 2018;36:311–37.
Wang S, Breskovska I, Gandhy S, Punga AR, Guptill JT, Kaminski HJ. Advances in autoimmune myasthenia gravis management. Expert Rev Neurother 2018;18:573–88. 10.1080/14737175.2018.1491310.
doi: 10.1080/14737175.2018.1491310
Konishi T. [Plasmapheresis in patients with myasthenia gravis. Nihon Rinsho 2008;66:1165–71.
Dhillon S. Eculizumab:A review in generalized myasthenia gravis. Drugs 2018;78:367–76.
Jordan A, Freimer M. Recent advances in understanding and managing myasthenia gravis. F1000Res 2018;7: F1000 Faculty Rev-1727. 10.12688/f1000research. 15973.1.
doi: 10.12688/f1000research.
Gajdos P, Chevret S, Toyka K. Plasma exchange for myasthenia gravis. Cochrane Database Syst Rev 2002;2002:CD002275. doi:10.1002/14651858. CD002275.
doi: 10.1002/14651858.
Gajdos P, Chevret S, Toyka K. Intravenous immunoglobulin for myasthenia gravis. Cochrane Database Syst Rev 2006:CD002277. doi:10.1002/14651858. CD002277.pub2.
doi: 10.1002/14651858.
Gronseth GS, Barohn RJ. Practice parameter:Thymectomy for autoimmune myasthenia gravis (an evidence-based review):Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2000;55:7–15.
Shrager JB, Deeb ME, Mick R, Brinster CJ, Childers HE, Marshall MB, et al. Transcervical thymectomy for myasthenia gravis achieves results comparable to thymectomy by sternotomy. Ann Thorac Surg 2002;74:320–6.
Levin N, Abramsky O, Lossos A, Karussis D, Siegal T, Argov Z, et al. Extrathymic malignancies in patients with myasthenia gravis. J Neurol Sci 2005;237:39–43.
Widjaja A, Rademaker J, Gölkel C, Holstein A, Leifke E, Wat N. [Graves ophthalmopathy and ocular myasthenia]. Ophthalmologe 2000;97:38–40. 97:38-40. 10.1007/s003470050008.
doi: 10.1007/s003470050008