Abstract
Introduction Hyperthyroidism in combination with myasthenia gravis, thyrotoxic myopathy, periodic paralysis, exophthalmic ophthalmoplegia, and acute thyrotoxic encephalomyopathy have been recognized as separate clinical entities. 1,2 Thyrotoxic myopathy and periodic paralysis remit upon treatment of the hyperthyroidism. Exophthalmic ophthalmoplegias may pursue a course independent of thyroid secreting activity. Acute thyrotoxic encephalomyopathy may be but a form of fulminating myasthenia gravis appearing in a thyroid crisis. 3,4 The relationship between hyperthyroidism and myasthenia gravis remains undefined. Estimates of the frequency of the occurrence of hyperthyroidism in patients with myasthenia gravis vary from 3% to 8.8%. 2,5-7 The higher percentage in the more recent series of Silver and Osserman 7 is perhaps the more accurate one. An inverse relationship between levels of thyroid activity and the severity of the myasthenia gravis has been endorsed by Thorner, McEachern, and Parnell, and Maclean and Wilson: either therapeutic or spontaneous abatement of the hyperthyroid state
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