Objective: To describe an association of Hashimotos thyroiditis and myasthenia gravis in a 16 years old girl.
Patient Report and Methods: A 18-year old girl with persistent hypothyroidism secondary to Hashimotos thyroiditis and a family history of Hashimotos thyroiditis (grandmother), diagnosed in 2005 and confirmed by elevation of thyroid stimulating hormone (TSH), low levels of T3, T4 and fT4 levels. The US of the thyroid gland revealed hyperechogenic and hypoechogenic zones. In 2016 the girl complained of extreme fatigue, and difficulties in opening bottles. The diagnosis of MG was confirmed by electromyographic (EMG) activity (decelerating burst). No serum antibody against acetylcholine receptor (AChR) and MuSK could be detected. She was followed up and treated with pyridostigmine sulphate. She undewent laparoscopic thymectomy and was treated further with corticosteroids and pyridostigmine sulphate (240 mg). In the following 4 months her muscle strength slightly improved, but there was no improvement in her feeling of fatigue.
Conclusion: Patients with autoimmune thyroid disease (AITD) are at a higher risk of developing other autoimmune disease (s). When a patient with AITD presents with new or nonspecific symptoms screening for a second autoimmune disorder should be done. One should exclude MG if AITD patient complains of muscle weakness, fatigue or double vision. In our patient, AITD preceded the occurrence of MG.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology