Pseudo-internuclear ophthalmoplegia as a sign of overlapping myasthenia gravis in a patient with 'intractable' hypothyroidism.

摘要: We describe a 52-year-old man with history of increasing fatigability and gait disturbances that were first attributed to hypothyroidism. On examination, he had bilateral pseudo-internuclear ophthalmoplegia weakness adduction abducting nystagmus. Convergence was also impaired showed proximal the limb. Intravenous edrophonium almost completely abolished nystagmus adducting muscle weakness, improved strength muscles groups. The clinical response administration edrophonium, presence AChR binding antibodes repetitive nerve stimulation test findings indicated patient as manifestation generalized myasthenia gravis. Whereas hypothyroidism effectively controlled levothyroxine, his subsequent thymectomy, prednisolone cholinesterase inhibitors confirmed diagnosis