June 09-41-2.indd - Kma.org.kw

June 2009KUWAIT MEDICAL JOURNAL 165Always suspect MG when a thyrotoxicosis patientwith lid retraction develops ptosis [12] . The historyof diurnal variation and clinically demonstrablefatigability will clinch the diagnosis. Apart fromtensilon test and repetitive nerve stimulation,acetylcholine receptor antibody and single fiberelectromyography are the other tests to confirm MG.This could not be done due to administrative reasons.Both MG and Graves’ disease are autoimmunedisorder against surface receptors with highprevalence and correlation [12] . Usually their responseto treatment with pyridostigmine will be dramatic.CONCLUSIONThis report highlights the need for physiciansto be alert regarding these rare manifestations ofthyrotoxicosis in their patients and initiate treatmentas it is difficult to obtain rapid laboratory confirmationin the emergency department.REFERENCES1. Boelaert K, Franklyn JA. Thyroid hormone in healthand disease. J Endocrinol 2005; 187:1-15.2. Cooper DS. Hyperthyroidism. Lancet 2003; 362:459-468.3. Wartofsky L. Thyrotoxic storm, In: BravermanLE, Utiger RD, editors. Werner and Ingbar’s ‘TheThyroid’. 7th ed. Philadelphia: Lippincott-Raven;1996. p 701-707.4. Duyff RF, Van den Bosch J, Laman DM, van LoonBJ, Linssen WH. Neuromuscular findings in thyroiddysfunction: a prospective clinical and electrodiagnosticstudy. J Neurol Neurosurg Psychiatry 2000; 68:750-755.5. Delong GR. Neuromuscular system and brain inthyrotoxicosis, In: Braverman LE, Utiger RD, editors.Werner and Ingbar’s ‘The Thyroid’. 7th ed. Philadelphia:Lippincott-Raven; 1996. p 645-652.6. Al-Shekhlee A, Kaminski HJ, Ruff RL. Endocrinemyopathies and muscle disorders related to electrolytedisturbance, In: Katiriji B, Kaminski HJ, Preston D,Shapiro B, Ruff RL, editors. Neuromuscular disordersin clinical practice. Boston: Butterworth-Heinemann;2002. p 1187-1204.7. Kothbauer-Margreiter I, Sturzenegger M, Komor J,Baumgartner R, Hess CW. Encephalopathy associatedwith Hashimoto thyroiditis: diagnosis and treatment. JNeurol 1996; 243:585-593.8. Newcomer J, Haire W, Hartman CR. Coma andthyrotoxicosis. Ann Neurol 1983; 14:689-690.9. Loeb JN. Metabolic changes in thyrotoxicosis, In:Braverman LE, Utiger RD, editors. Werner and Ingbar’s‘The Thyroid’. 7th ed. Philadelphia: Lippincott-Raven;1996. p 687-692.10. Jacobson DM. Dysthyroid orbitopathy. Semin Neurol2000; 20:43-54.11. Tani J, Wall JR. Autoimmunity against eyemuscleantigens may explain thyroid-associatedophthalmopathy. CMAJ 2006; 175:239.12. Abend WK, Tyler HR. Thyroid disease and nervoussystem, In: Aminoff MJ, editor. Neurology and generalmedicine. 2nd ed. New York: Churchill Livingston;1995. p 333-347.