title: Presumed isotretinoin-induced, concomitant autoimmune thyroid disease and ocular myasthenia gravis: a case report.
abstract: BACKGROUND
  There are many adverse effects that have been described for isotretinoin. To the best of our knowledge, this is the first report of a possible association of oral isotretinoin intake with autoimmune thyroiditis and ocular myasthenia gravis (OMG).
  
  
  METHODS
  A 19-year-old Caucasian male, who had used oral isotretinoin for severe acne disease for the previous six months, was referred to our clinic. He had a three-week history of diplopia and variable bilateral ptosis. Physical examination showed moderate periorbital edema and limitations of up- and down-gaze in the left eye. Laboratory findings and thyroid ultrasound were consistent with autoimmune thyroiditis. Antithyroid therapy did not relieve the clinical symptoms. Concomitant OMG was suspected. Variable ptosis and a positive response to oral prednisolone of 40 mg/day and pyridostigmine of 360 mg/day supported the diagnosis of concomitant autoimmune thyroiditis and OMG.
  
  
  CONCLUSIONS
  Autoimmune disorders may be triggered by oral isotretinoin treatment. Clinicians prescribing isotretinoin should be aware of the possible association between isotretinoin intake and concomitant autoimmune thyroiditis and OMG.
authors.affiliation: Eskisehir Osmangazi University Medical Faculty, Department of Ophthalmology, Eskisehir, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Gursoy
authors.forename: Idil
authors.initials: I
authors.lastname: Cakmak
authors.forename: Nilgun
authors.initials: N
authors.lastname: Yildirim
authors.forename: Hikmet
authors.initials: H
authors.lastname: Basmak
keywords: Isotretinoin; Ocular myasthenia gravis; Thyroiditis