title: [Graves ophthalmopathy and ocular myasthenia].
abstract: BACKGROUND
  An 18-year-old woman presented with thyrotoxic symptoms - right sided lid retraction and exophthalmus. She complained of diplopia on lateral gaze. Laboratory investigations confirmed Grave's disease with hyperthyroidism and TSH receptor antibodies.
  
  
  METHODS
  Her clinical symptoms improved after thyrostatic and steroid therapy. However, diplopia recurred 2 weeks after withdrawal of steroid therapy and a ptosis of the left lid appeared for the first time.
  
  
  RESULTS
  A positive Tensilon test and electromyographic findings confirmed the diagnosis of myasthenia gravis with a predominantly ocular manifestation. Diplopia and ptosis improved with oral pyridostigmine.
  
  
  CONCLUSIONS
  The coexistence of myasthenia gravis should be taken into consideration in the management of patients with Graves' ophthalmopathy.
authors.affiliation: Abteilung klinische Endokrinologie und diagnostische Radiologie, Medizinische Hochschule Hannover und Department of Endocrinology, Queen Mary Hospital, Hong Kong.
authors.forename: A
authors.initials: A
authors.lastname: Widjaja
authors.forename: J
authors.initials: J
authors.lastname: Rademaker
authors.forename: C
authors.initials: C
authors.lastname: Gölkel
authors.forename: A
authors.initials: A
authors.lastname: Holstein
authors.forename: E
authors.initials: E
authors.lastname: Leifke
authors.forename: N
authors.initials: N
authors.lastname: Wat
mesh_terms: D000293:Adolescent; D001763:Blepharoptosis / Q000209:etiology; D003937:Diagnosis, Differential; D004172:Diplopia / Q000209:etiology; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D009157:Myasthenia Gravis / Q000150:complications* / Q000175:diagnosis