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Prednisone Use in Concurrent Autoimmune Diseases: Treatment of a Patient With Myasthenia Gravis, Hyperthyroidism, and Polymyositis

Prednisone Use in Concurrent Autoimmune Diseases: Treatment of a Patient With Myasthenia Gravis,... Abstract • A 40-year-old woman with clinical and laboratory features of myasthenia gravis, hyperthyroidism, and polymyositis responded to treatment with prednisone alone. Symptoms of myasthenia gravis appeared first followed by hyperthyroid symptoms. Triiodothyronine, thyroxine, and thyroid uptake were elevated as were serum levels of CPK, SGOT, SGPT, and LDH. Muscle biopsy specimen showed mild type II fiber atrophy and a small focus of inflammatory cells. Two weeks after initiation of prednisone, 100 mg every other day, the ESR declined from 44 to 12 mm/hr, serum enzyme values became normal, and the weakness improved. Over the ensuing four months, the thyroid function values returned to normal and the patient no longer needed any anticholinesterase drug. At present, she is functionally normal except for mild defects in eye movement and she takes no medication. Physicians should consider treating patients who have several concurrent autoimmune diseases with prednisone to see if all conditions can be brought under control with one simple therapy. References 1. Bender AN, Ringel SP, Engel WK, et al: Myasthenia gravis: A serum factor blocking acetylcholine receptor of the human neuromuscular junction . Lancet 1:607-609, 1975.Crossref 2. Millikan CH, Haines SF: The thyroid gland in relation to neuromuscular disease . Arch Intern Med 92:5-39, 1953.Crossref 3. Osserman KE, Tasiris P, Weiner LB: Myasthenia gravis and thyroid disease: Clinical and immunological correlation . Mt Sinai J Med 34:469-483, 1967. 4. Simpson JS: The correlation between myasthenia gravis and disorders of the thyroid gland , in Research in Muscular Dystrophy . London, Pitman Medical Publishing Co Ltd, 1968, vol 1, pp 31-44. 5. Mori M, Takamore M: Hyperthyroidism and myasthenia gravis with features of Eaton-Lambert syndrome . Neurology 26:882-887, 1976.Crossref 6. Durston JH: Myasthenia gravis, Hashimoto's disease and pernicious anemia . Postgrad Med J 45:290-291, 1969.Crossref 7. Simpson JA: Myasthenia gravis as an autoimmune disease: Clinical aspects . Ann NY Acad Sci 135:506-516, 1966.Crossref 8. Becker KL, Titus JL, McConahey WM, et al: Morphological evidence of thyroiditis in myasthenia gravis . JAMA 187:994-996, 1964.Crossref 9. Oosterhuis HJ, DeHaas WHD: Rheumatic diseases in patients with myasthenia gravis: An epidemiological and clinical investigation . Acta Neurol Scand 44:219-227, 1968.Crossref 10. Turner JWA: Myasthenia gravis . Proc R Soc Med 67:763-769, 1974. 11. Aarli JA, Milde E-J, Thunold S: Arthritis in myasthenia gravis . J Neurol Neurosurg Psychiatry 38:1048-1055, 1975.Crossref 12. Wolf SM, Rowland LP, Schotland DL, et al: Myasthenia as an autoimmune disease: Clinical aspects . Ann NY Acad Sci 135:517-535, 1966.Crossref 13. Oosterhuis HJ, Bethlem J: Neurogenic muscle involvement in myasthenia gravis: Clinical and histopathological study . J Neurol Neurosurg Psychiatry 36:244-254, 1973.Crossref 14. Downes JM, Greenwood BM, Wray SH: Auto-immune aspects of myasthenia gravis . Q J Med 35:85-105, 1966. 15. Simpson JA: The defect in myasthenia gravis , in Bittar EE, Bittar N (eds): The Biological Basis of Medicine . New York, Academic Press Inc, 1969, vol 3, p 345. 16. Vetters JM, Saikia NK, Wood J, et al: Pemphigus vulgaris and myasthenia gravis . Br J Dermatol 88:437-441, 1973.Crossref 17. Peck SM, Ossermann KE, Weiner LB, et al: Studies in bullous diseases: Immunofluorescent serologic tests . N Engl J Med 279:951-958, 1968.Crossref 18. Noguchi S, Nishitani H: Immunologic studies of a case of myasthenia gravis associated with pemphigus vulgaris after thymectomy . Neurology 26:1075-1080, 1976.Crossref 19. Patten BM, Hart A, Lovelace R: Multiple sclerosis associated with defects in neuromuscular transmission . J Neurol Neurosurg Psychiatry 35:385-394, 1972.Crossref 20. Aita JF, Snyder DH, Reichl W: Myasthenia gravis and multiple sclerosis: An unusual combination of diseases . Neurology 24:72-75, 1974.Crossref 21. Chaco J: Multiple sclerosis with impaired neuromuscular transmission . Confin Neurol 36:182-185, 1974.Crossref 22. Achari AN, Trontels JV, Campos RJ: Multiple sclerosis and myasthenia gravis . Neurology 26:544-546, 1976.Crossref 23. Johns TR, Crowley WJ, Miller JQ, et al: The syndrome of myasthenia and polymyositis with comments on therapy . Ann NY Acad Sci 183:64-71, 1971.Crossref 24. Dubowitz V, Brooke WH: Muscle Biopsy: A Modern Approach . London, WB Saunders Co Ltd, 1973. 25. Patten BM, Oliver KL, Engel WK: Adverse interaction between steroid hormones and anticholinesterase drugs . Neurology 24:442-449, 1974.Crossref 26. Seybold ME, Drachman DB: Gradually increasing doses of prednisone in myasthenia gravis . N Engl J Med 290:81-84, 1974.Crossref 27. Herishana Y, Rosenberg R: Beta-blockers and myasthenia gravis . Ann Intern Med 83:834-835, 1975.Crossref 28. Ramsay I: Thyroid Disease and Muscle Dysfunction . Chicago, William Heinemann Medical Books, 1974, pp 53-95. 29. Gunn A, Michie W, Irvine WJ: The thymus in thyroid disease . Lancet 2:776-778, 1964.Crossref 30. Michie W, Beck JS, Mahaffy RG, et al: Quantitative radiological and histological studies of the thymus in thyroid disease . Lancet 1:691-695, 1967.Crossref 31. Castleman B: The pathology of the thymus gland in myasthenia gravis . Ann NY Acad Sci 135:496-503, 1966.Crossref 32. Smith BR, Hall R: Thyroid-stimulating immunoglobulins in Grave's disease . Lancet 2:427-431, 1974.Crossref 33. Grumet FC, Payne RO, Konishi J, et al: HL-A antigens as markers for disease susceptibility and autoimmunity in Grave's disease . J Clin Endocrinol Metab 39:1115-1119, 1974.Crossref 34. Fritze D, Herrmann C Jr, Naeim F, et al: The biologic significance of HL-A antigen markers in myasthenia gravis . Ann NY Acad Sci 274:440-450, 1976.Crossref 35. Hofmann WM, Denys E: Effects of thyroid hormone at the neuromuscular junction . Am J Physiol 223:283-287, 1972. 36. Kissel P, Hartemann P, Duc M: Les syndromes myothyroidiens . Paris, Masson & Cie, 1965. 37. Hertzel BS: The etiology and pathogenesis of hyperthyroidism . Postgrad Med J 44:363-376, 1968.Crossref 38. Snyder NJ, Green DE, Solomon DH: Gluco-corticoid induced disappearance of long acting thyroid stimulator in the ophthalmopathy of Grave's disease . J Clin Endocrinol 24:1129-1135, 1964.Crossref 39. Werner SC, Platman SR: Remission of hyperthyroidism (Grave's disease) and altered pattern of serum-thyroxin binding induced by prednisone . Lancet 2:751-756, 1965.Crossref 40. Matel G, Bergstrom K, Franksson C, et al: Effects of some immunosuppressive procedures on myasthenia gravis . Ann NY Acad Sci 274:659-676, 1976.Crossref 41. Mann JD, Johns TR, Campa JF: Long-term administration of corticosteroids in myasthenia gravis . Neurology 26:729-740, 1976.Crossref 42. Jenkins RB: Treatment of myasthenia gravis with prednisone . Lancet 1:765-767, 1972.Crossref 43. Warmolts JR, Engel WK: Benefit from alternate-day prednisone in myasthenia gravis . N Engl J Med 286:17-20, 1972.Crossref 44. Vejjajiva A: Treatment of myasthenia gravis and hyperthyroidism with high dosage prednisolone, in Proceedings of Third International Congress on Muscle Diseases, Newcastle, England. Amsterdam, Excerpta Medica, 1974. 45. Ingbar SH, Wocher KA: The thyroid gland , in Williams RH (ed): Textbook of Endocrinology . Philadelphia, WB Saunders Co, 1974. 46. Papatestas AE, Genkins G, Horowitz SH, et al: Thymectomy in myasthenia gravis: Pathologic, clinical and electrophysiologic correlations . Ann NY Acad Sci 274:555-573, 1976.Crossref 47. DeGroot LJ, Perlo V, Gephart T, et al: Remission of myasthenia and thyrotoxicosis after thymectomy . Ann Intern Med 67:1042-1044, 1967.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Prednisone Use in Concurrent Autoimmune Diseases: Treatment of a Patient With Myasthenia Gravis, Hyperthyroidism, and Polymyositis

Archives of Neurology , Volume 36 (2) – Feb 1, 1979

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Publisher
American Medical Association
Copyright
Copyright © 1979 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1979.00500380073009
Publisher site
See Article on Publisher Site

Abstract

Abstract • A 40-year-old woman with clinical and laboratory features of myasthenia gravis, hyperthyroidism, and polymyositis responded to treatment with prednisone alone. Symptoms of myasthenia gravis appeared first followed by hyperthyroid symptoms. Triiodothyronine, thyroxine, and thyroid uptake were elevated as were serum levels of CPK, SGOT, SGPT, and LDH. Muscle biopsy specimen showed mild type II fiber atrophy and a small focus of inflammatory cells. Two weeks after initiation of prednisone, 100 mg every other day, the ESR declined from 44 to 12 mm/hr, serum enzyme values became normal, and the weakness improved. Over the ensuing four months, the thyroid function values returned to normal and the patient no longer needed any anticholinesterase drug. At present, she is functionally normal except for mild defects in eye movement and she takes no medication. Physicians should consider treating patients who have several concurrent autoimmune diseases with prednisone to see if all conditions can be brought under control with one simple therapy. References 1. Bender AN, Ringel SP, Engel WK, et al: Myasthenia gravis: A serum factor blocking acetylcholine receptor of the human neuromuscular junction . Lancet 1:607-609, 1975.Crossref 2. Millikan CH, Haines SF: The thyroid gland in relation to neuromuscular disease . Arch Intern Med 92:5-39, 1953.Crossref 3. Osserman KE, Tasiris P, Weiner LB: Myasthenia gravis and thyroid disease: Clinical and immunological correlation . Mt Sinai J Med 34:469-483, 1967. 4. Simpson JS: The correlation between myasthenia gravis and disorders of the thyroid gland , in Research in Muscular Dystrophy . London, Pitman Medical Publishing Co Ltd, 1968, vol 1, pp 31-44. 5. Mori M, Takamore M: Hyperthyroidism and myasthenia gravis with features of Eaton-Lambert syndrome . Neurology 26:882-887, 1976.Crossref 6. Durston JH: Myasthenia gravis, Hashimoto's disease and pernicious anemia . Postgrad Med J 45:290-291, 1969.Crossref 7. Simpson JA: Myasthenia gravis as an autoimmune disease: Clinical aspects . Ann NY Acad Sci 135:506-516, 1966.Crossref 8. Becker KL, Titus JL, McConahey WM, et al: Morphological evidence of thyroiditis in myasthenia gravis . JAMA 187:994-996, 1964.Crossref 9. Oosterhuis HJ, DeHaas WHD: Rheumatic diseases in patients with myasthenia gravis: An epidemiological and clinical investigation . Acta Neurol Scand 44:219-227, 1968.Crossref 10. Turner JWA: Myasthenia gravis . Proc R Soc Med 67:763-769, 1974. 11. Aarli JA, Milde E-J, Thunold S: Arthritis in myasthenia gravis . J Neurol Neurosurg Psychiatry 38:1048-1055, 1975.Crossref 12. Wolf SM, Rowland LP, Schotland DL, et al: Myasthenia as an autoimmune disease: Clinical aspects . Ann NY Acad Sci 135:517-535, 1966.Crossref 13. Oosterhuis HJ, Bethlem J: Neurogenic muscle involvement in myasthenia gravis: Clinical and histopathological study . J Neurol Neurosurg Psychiatry 36:244-254, 1973.Crossref 14. Downes JM, Greenwood BM, Wray SH: Auto-immune aspects of myasthenia gravis . Q J Med 35:85-105, 1966. 15. Simpson JA: The defect in myasthenia gravis , in Bittar EE, Bittar N (eds): The Biological Basis of Medicine . New York, Academic Press Inc, 1969, vol 3, p 345. 16. Vetters JM, Saikia NK, Wood J, et al: Pemphigus vulgaris and myasthenia gravis . Br J Dermatol 88:437-441, 1973.Crossref 17. Peck SM, Ossermann KE, Weiner LB, et al: Studies in bullous diseases: Immunofluorescent serologic tests . N Engl J Med 279:951-958, 1968.Crossref 18. Noguchi S, Nishitani H: Immunologic studies of a case of myasthenia gravis associated with pemphigus vulgaris after thymectomy . Neurology 26:1075-1080, 1976.Crossref 19. Patten BM, Hart A, Lovelace R: Multiple sclerosis associated with defects in neuromuscular transmission . J Neurol Neurosurg Psychiatry 35:385-394, 1972.Crossref 20. Aita JF, Snyder DH, Reichl W: Myasthenia gravis and multiple sclerosis: An unusual combination of diseases . Neurology 24:72-75, 1974.Crossref 21. Chaco J: Multiple sclerosis with impaired neuromuscular transmission . Confin Neurol 36:182-185, 1974.Crossref 22. Achari AN, Trontels JV, Campos RJ: Multiple sclerosis and myasthenia gravis . Neurology 26:544-546, 1976.Crossref 23. Johns TR, Crowley WJ, Miller JQ, et al: The syndrome of myasthenia and polymyositis with comments on therapy . Ann NY Acad Sci 183:64-71, 1971.Crossref 24. Dubowitz V, Brooke WH: Muscle Biopsy: A Modern Approach . London, WB Saunders Co Ltd, 1973. 25. Patten BM, Oliver KL, Engel WK: Adverse interaction between steroid hormones and anticholinesterase drugs . Neurology 24:442-449, 1974.Crossref 26. Seybold ME, Drachman DB: Gradually increasing doses of prednisone in myasthenia gravis . N Engl J Med 290:81-84, 1974.Crossref 27. Herishana Y, Rosenberg R: Beta-blockers and myasthenia gravis . Ann Intern Med 83:834-835, 1975.Crossref 28. Ramsay I: Thyroid Disease and Muscle Dysfunction . Chicago, William Heinemann Medical Books, 1974, pp 53-95. 29. Gunn A, Michie W, Irvine WJ: The thymus in thyroid disease . Lancet 2:776-778, 1964.Crossref 30. Michie W, Beck JS, Mahaffy RG, et al: Quantitative radiological and histological studies of the thymus in thyroid disease . Lancet 1:691-695, 1967.Crossref 31. Castleman B: The pathology of the thymus gland in myasthenia gravis . Ann NY Acad Sci 135:496-503, 1966.Crossref 32. Smith BR, Hall R: Thyroid-stimulating immunoglobulins in Grave's disease . Lancet 2:427-431, 1974.Crossref 33. Grumet FC, Payne RO, Konishi J, et al: HL-A antigens as markers for disease susceptibility and autoimmunity in Grave's disease . J Clin Endocrinol Metab 39:1115-1119, 1974.Crossref 34. Fritze D, Herrmann C Jr, Naeim F, et al: The biologic significance of HL-A antigen markers in myasthenia gravis . Ann NY Acad Sci 274:440-450, 1976.Crossref 35. Hofmann WM, Denys E: Effects of thyroid hormone at the neuromuscular junction . Am J Physiol 223:283-287, 1972. 36. Kissel P, Hartemann P, Duc M: Les syndromes myothyroidiens . Paris, Masson & Cie, 1965. 37. Hertzel BS: The etiology and pathogenesis of hyperthyroidism . Postgrad Med J 44:363-376, 1968.Crossref 38. Snyder NJ, Green DE, Solomon DH: Gluco-corticoid induced disappearance of long acting thyroid stimulator in the ophthalmopathy of Grave's disease . J Clin Endocrinol 24:1129-1135, 1964.Crossref 39. Werner SC, Platman SR: Remission of hyperthyroidism (Grave's disease) and altered pattern of serum-thyroxin binding induced by prednisone . Lancet 2:751-756, 1965.Crossref 40. Matel G, Bergstrom K, Franksson C, et al: Effects of some immunosuppressive procedures on myasthenia gravis . Ann NY Acad Sci 274:659-676, 1976.Crossref 41. Mann JD, Johns TR, Campa JF: Long-term administration of corticosteroids in myasthenia gravis . Neurology 26:729-740, 1976.Crossref 42. Jenkins RB: Treatment of myasthenia gravis with prednisone . Lancet 1:765-767, 1972.Crossref 43. Warmolts JR, Engel WK: Benefit from alternate-day prednisone in myasthenia gravis . N Engl J Med 286:17-20, 1972.Crossref 44. Vejjajiva A: Treatment of myasthenia gravis and hyperthyroidism with high dosage prednisolone, in Proceedings of Third International Congress on Muscle Diseases, Newcastle, England. Amsterdam, Excerpta Medica, 1974. 45. Ingbar SH, Wocher KA: The thyroid gland , in Williams RH (ed): Textbook of Endocrinology . Philadelphia, WB Saunders Co, 1974. 46. Papatestas AE, Genkins G, Horowitz SH, et al: Thymectomy in myasthenia gravis: Pathologic, clinical and electrophysiologic correlations . Ann NY Acad Sci 274:555-573, 1976.Crossref 47. DeGroot LJ, Perlo V, Gephart T, et al: Remission of myasthenia and thyrotoxicosis after thymectomy . Ann Intern Med 67:1042-1044, 1967.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Feb 1, 1979

References

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