THE ASSOCIATION OF GRAVES' DISEASE WITH MYASTHENIA GRAVIS, WITH A REPORT OF FIVE CASES

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Abstract
Five cases of Graves'' disease associated with myasthenia gravis have recently been observed. Muscular disorders seen in thyrotoxicosis, reported as thyrotoxic myopathy or exophthalmic ophthalmoplegia, may often be on the basis of true myasthenia gravis. Dramatic response to neostigmine and sensitivity to curare, in our present state of knowledge, must be considered to be specific diagnostic tests for myasthenia gravis. These tests were used in the diagnosis of the authors'' cases, and in 2 cases the response was shown graphically by the use of electromyography. The controversy concerning the response of symptoms, thought to be those of myasthenia gravis, to the medical or surgical therapy of an associated thyrotoxicosis is discussed. In 3 of 5 cases there were periods of control of hyperthyroidism with no apparent effect on the myasthenia gravis. All cases of the syndrome of myasthenia gravis and thyrotoxicosis should be subjected to the most direct and definitive control of the thyrotoxicosis because of the deleterious effect of prolonged untreated thyrotoxicosis on the conomy of the body.

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