Abstract
About 85% of patients with myasthenia gravis present with ptosis and generalised muscle weakness, but 15% may present with pure bulbar symptoms which can be misdiagnosed. We describe a 60-year old female patient with multinodular goitre who had symptom of dysphagia and was subjected to total thyroidectomy. Post-operatively she developed respiratory distress and had difficulty in phonation. Bilateral vocal cord palsy was identified and emergency tracheostomy was done. Review of the patient revealed a mass in the anterior mediastinum and the patient showed improvement with pyridostigmine. Thymoma was confirmed in the computed tomography scan. This case highlights the unanticipated problems faced due to an undiagnosed myasthenia gravis and the importance of having a high index of suspicion of myasthenia gravis in patients with subtle bulbar symptoms.
Highlights
Myasthenia Gravis (MG) is a chronic autoimmune disease characterized by fatigable skeletal muscle weakness
About 85% of patients present with ptosis and generalised muscle weakness, but 15% may present with bulbar symptoms like dysphagia, dysphonia and dysarthria.[1]
Had MG been diagnosed before surgery, drugs or thymectomy would have alleviated her symptoms
Summary
Myasthenia Gravis (MG) is a chronic autoimmune disease characterized by fatigable skeletal muscle weakness. Key-words: thyroid surgery, myasthenia gravis bulbar symptoms, myasthenia: muscle relaxant effects, myasthenia gravis: postoperative management. About 85% of patients present with ptosis and generalised muscle weakness, but 15% may present with bulbar symptoms like dysphagia, dysphonia and dysarthria.[1] This is seen especially with late ageonset MG and this group can be misdiagnosed. We present a rare case of undiagnosed bulbar MG who presented as a thyroid mass and had postoperative complications after surgery.
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