Myasthenia gravis associated with Graves

Mouna Elleuch; Hamza Elfekih; Faten Hadjkacem; Mahdi Kalthoum; Mouna Ammar; Nabila Rekik; Wajdi Safi; Mouna Mnif; Mohamed Abid

doi:10.1530/endoabs.49.EP770

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Endocrine Abstracts (2017) 49 EP770 | DOI: 10.1530/endoabs.49.EP770

ECE2017 Eposter Presentations: Interdisciplinary Endocrinology Clinical case reports - Thyroid/Others (13 abstracts)

Myasthenia gravis associated with Graves’ disease and adrenal insufficiency

Mouna Elleuch , Hamza Elfekih , Faten Hadjkacem , Mahdi Kalthoum , Mouna Ammar , Nabila Rekik , Wajdi Safi , Mouna Mnif & Mohamed Abid

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Hedi-Chaker University Hospital, Sfax, Tunisia.

Introduction: Multiple autoimmune syndrome (MAS) is a rare condition, first described by Humbert and Dupond in 1988 and characterised by three or more autoimmune disorders in the same individual.

Case description: Here we present a case of 14-year-old female patient diagnosed with ocular myasthenia gravis. The diagnosis of Graves’ disease was suspected on the basis of hyperthyroidism symptoms and confirmed by undetectable TSH level (<0.01 mUI/l) with high FT₄ level (27.8 pmol/l). The adrenal insufficiency was suspected also clinically (extreme fatigue, weight loss, hyperpigmentation and low blood pressure) and accepted with a low cortisol level (37.4 ng/ml). The patient has improved after taking an anticholinesterase agent and corticosteroid replacement therapy. For the hyperthyroidism, a radical treatment is recommended and the Beta-blockers should be avoided.

Conclusion: The MAS-3 in our case is characterized by the association of myasthenia gravis, Graves’ disease and adrenal insufficiency in which every condition has a different treatment and prognosis in addition to a multidisciplinary care.