Concurrence of Myasthenia Gravis and Thyroid Disorders: A Retrospective Database Study

Sasivimol Virameteekul, Suranut Charoensri, Kittisak Sawanyawisuth, Somsak Tiamkao

Abstract

Introduction. Both myasthenia gravis (MG) and autoimmune thyroid diseases (AITDs) are autoimmune diseases. Graves’disease (GD) is the most common AITD reported to be associated with MG. Currently, there is limited data on prevalence and clinical features/outcomes of MG in various thyroid diseases in a large database report.

Methodology. A total of 872 patients with MG and 97,251 patients with thyroid disorders had been recorded by the tertiary hospital database. The study period was between 1997 and 2017. Patients with a thyroid disorder and MG were identified by the ICD-10-CM code. Clinical courses of MG accompanied by thyroid disorders were studied.

Results. During the 20-year study period, there were 872 patients with MG and 97,251 patients with thyroid disorders. In the group with thyroid disorders, 28,886 patients (29.70%) had GD, 1,612 patients (1.66%) had Hashimoto’s thyroiditis, 13,172 patients (13.54%) had toxic goiter and 53,581 patients (55.10%) had nontoxic goiter. 97 patients had been diagnosed with both MG and thyroid disorders. Among the four types of thyroid disorders, the rate of MG was highest in HT group (9.92/1,000 HT patients). There were four significant factors among four groups of thyroid disorders including age of onset of thyroid disease (p 0.004), MG classification (ppp 0.034). Among the four groups of thyroid disorders, patients with MG and HT were diagnosed with thyroid disease at the youngest age (27 years) compared with other thyroid diseases. Additionally, the MG patients with HT also had the highest proportion of MG class 4-5 a/b (7 patients, 43.75%), received prednisolone treatment (15 patients, 93.75%), received immunosuppressants (9 patients, 56.25%), received IVIG or PLEX (5 patients, 31.30%), and had thymoma (6 patients, 46.15%).

Conclusion. MG is most prevalent in patients with HT. Patients with both MG and HT had more severe MG status and had higher rate of thymoma.

Keywords

autoimmune thyroid diseases, prevalence, treatment

Full Text:

Abstract HTML PDF

References

Patrick J, Lindstrom J. Autoimmune response to acetylcholine receptor. Science. 1973;180(4088):871-2. PMID: 4706680. https://doi.org/10.1126/science.180.4088.871.

Hoch W, McConville J, Helms S, Newsom-Davis J, Melms A, Vincent A. Auto-antibodies to the receptor tyrosine kinase MuSK in patients with myasthenia gravis without acetylcholine receptor antibodies. Nat Med. 2001;7(3):365-8. PMID: 11231638. https://doi.org/10.1038/85520.

Conti-Fine BM, Milani M, Kaminski HJ. Myasthenia gravis: Past,present, and future. J Clin Invest. 2006;116(11):2843-54. PMID:17080188.PMCID: PMC1626141. https://doi.org/10.1172/JCI29894.

Phillips LH 2nd. The epidemiology of myasthenia gravis. Ann N Y Acad Sci. 2003;998:407-12. PMID: 14592908. https://doi.org/10.1196/annals.1254.053.

Grob D, Brunner N, Namba T, Pagala M. Lifetime course of myasthenia gravis. Muscle Nerve. 2008;37(2):141-9. PMID: 18059039. https://doi.org/10.1002/mus.20950.

Viegas S, Vincent A. Chapter 54 - Myasthenia Gravis and Related Disorders. In: Rose NR, Mackay IR, editors. The Autoimmune Diseases (Fifth Edition). Boston: Academic Press; 2014.

Rennie GE. Exopthalmic goitre combined with myasthenia gravis. Rev Neurol Psychiatry. 1908;6:229-33.

Marinó M, Ricciardi R, Pinchera A, et al. Mild clinical expression of myasthenia gravis associated with autoimmune thyroid diseases. J Clin Endocrinol Metab. 1997;82(2):438-43. PMID: 9024233. https://doi.org/10.1210/jcem.82.2.3749.

Mamarabadi M, Razjouyan H, Moghaddasi M. Hypothyroidism, the main thyroid dysfunction in Iranian patients with myasthenia gravis: A case serie. Iran. J. Neurol. 2011;10(1-2):22-5. PMID: 24250839.PMCID: PMC3829217.

Drachman DB. Myasthenia gravis. N Engl J Med. 1994;330(25):1797-810. PMID: 8190158. https://doi.org/10.1056/NEJM199406233302507.

Kiessling WR, Finke R, Kotulla P, Schleusener H. Circulating TSH-binding inhibiting immunoglobulins in myasthenia gravis. Acta Endocrinol (Copenh). 1982;101(1):41-6. PMID: 7124292. https://doi.org/10.1530/acta.0.1010041.

Peacey SR, Belchetz PE. Graves' disease: Associated ocular myasthenia gravis and a thymic cyst. J R Soc Med. 1993;86(5):297-8. PMID: 8505758.PMCID: PMC1294012.

Drachman DB. Myasthenia Gravis and the thyroid gland. N Engl J Med. 1962;266(7):330-3. https://doi.org/10.1056/NEJM196202152660703.

Galbraith RF, Summerskill WH, Murray J. Systemic lupus

erythematosus, cirrhosis and ulcerative colitis after thymectomy for myasthenia gravis. N Engl J Med. 1964;270:229-32. PMID: 14072077.https://doi.org/10.1056/NEJM196401302700504.

Garlepp MJ, Dawkins RL, Christiansen FT, et al. Autoimmunity in ocular and generalised myasthenia gravis. J Neuroimmunol.1981;1(3):325-32. PMID: 7334085. https://doi.org/10.1016/0165-5728(81)90035-7.

Tola MR, Caniatti LM, Casetta I, et al. Immunogenetic heterogeneity and associated autoimmune disorders in myasthenia gravis: A population-based survey in the province of Ferrara, northern Italy. Acta Neurol Scand. 1994;90(5):318-23. PMID: 7887131. https://doi.org/10.1111/j.1600-0404.1994.tb02731.x.

Thorlacius S, Aarli JA, Riise T, Matre R, Johnsen HJ. Associated

disorders in myasthenia gravis: Autoimmune diseases and their

relation to thymectomy. Acta Neurol Scand. 1989;80(4):290-5. PMID:2816285. https://doi.org/10.1111/j.1600-0404.1989.tb03881.x.

Scherbaum WA, Schumm F, Maisch B, et al. Myasthenia gravis: Overlap with 'polyendocrine' autoimmunity. Klin Wochenschr. 1983;61(10):509-15. PMID: 6876683. https://doi.org/10.1007/bf01488718.

Aarli JA, Gilhus NE, Matre R. Myasthenia gravis with thymoma is not associated with an increased incidence of non-muscle autoimmune disorders. Autoimmunity. 1992;11(3):159-62. PMID: 1571478. https://doi.org/10.3109/08916939209035150.

Christensen PB, Jensen TS, Tsiropoulos I, et al. Associated autoimmune diseases in myasthenia gravis. A population-based study. Acta Neurol Scand. 1995;91(3):192-5. PMID: 7793234. https://doi.org/10.1111/j.1600-0404.1995.tb00432.x.

Meriggioli MN, Sanders DB. Autoimmune myasthenia gravis:Emerging clinical and biological heterogeneity. Lancet Neurol.2009;8(5):475-90. PMID: 19375665. PMCID: PMC2730933. https://doi.org/10.1016/S1474-4422(09)70063-8.

Juel VC, Massey JM. Myasthenia gravis. Orphanet J Rare Dis. 2007;2:44. PMID: 17986328. PMCID: PMC2211463. https://doi.org/10.1186/1750-1172-2-44.

Cavalcante P, Bernasconi P, Mantegazza R. Autoimmune mechanisms in myasthenia gravis. Curr Opin Neurol. 2012;25(5):621-9. PMID:22941261. https://doi.org/10.1097/WCO.0b013e328357a829.

Kanazawa M, Shimohata T, Tanaka K, Nishizawa M. Clinical features of patients with myasthenia gravis associated with autoimmune diseases. Eur J Neurol. 2007;14(12):1403-4. PMID: 17941854. https://doi.org/10.1111/j.1468-1331.2007.01978.x.

Chen YP, Wei DN, Chen B. [The clinical features of myasthenia gravis associated with thyroid abnormalities]. Zhonghua Nei Ke Za Zhi. 2010;49(7):602-5. PMID: 20979773.

Mao ZF, Yang LX, Mo XA, et al. Frequency of autoimmune diseases in myasthenia gravis: a systematic review. Int J Neurosci. 2011;121(3):121-9. PMID: 21142828. https://doi.org/10.3109/00207454.2010.539307.

Klein R, Marx A, Ströbel P, Schalke B, Nix W, Willcox N. Autoimmune associations and autoantibody screening show focused recognition in patient subgroups with generalized myasthenia gravis. Hum Immunol.2013;74(9):1184-93. PMID: 23792059. https://doi.org/10.1016/j.humimm.2013.06.020.

Lopomo A, Berrih-Aknin S. Autoimmune thyroiditis and myasthenia gravis. Front Endocrinol (Lausanne). 2017;8:169. PMID: 28751878. PMCID: PMC5508005. https://doi.org/10.3389/fendo.2017.00169.