Wednesday, September 3, 2014
Hashimoto`s and Myasthenia Gravis
I apologize for the length. I was recently diagnosed with Hashimoto`s (July 2009) and am working with an Endocrinologist to keep my goiter from growing any larger by Levothyroxine. My first Endo and an ENT surgeon thought I should have my thyroid removed because of my issues with choking and hoarse voice. However, when speaking with the ENT surgeon, I did state that the hoarse voice comes and goes and at times it takes some effort to talk. The choking is also intermittent. The ENT doc was somewhat surprised that these symptoms come and go. I sometimes experience blurred vision (no double vision), my eyes feel tired most days, and do notice a slight difference in my right eyelid at times (though it is not a pronounced droopiness) and it is not enough to be noticed by others. There have been occasions where my right leg will drag when I walk which has caused me to stumble or come close. Because of Hashimoto`s, I am finding it hard to determine muscle weakness versus muscle achiness and general fatigue (which I have been struggling with due to Hashimoto’s). I do notice that I do not have the strength I had maybe five years ago but determined it was because I was getting older. I am 43. I find it difficult to make a flight of stairs since I get tired before the reaching the top. Many activities are harder for me since it requires so much effort and I get tired very quickly and can sometimes get out of breathe (I golf and bowl). When coloring my hair, I have to rest my arms since this requires me to hold my arms up for a period of time. I recently went to a new PCP (family doc) and asked about the possibility of MG and was told it would be very sudden and apparent if I had it. I am concerned about having my thyroid out if the choking and hoarse voice is not being caused by my goiter (due to the intermittence of the symptoms). My PCP suggested that I might be depressed. I want to setup an appointment with a neurologist to rule out MG prior to having my thyroid out, however I have spent a lot of time and money already trying to get to the Hashimoto’s diagnosis (my TPO was elevated to confirm diagnoses). I had gone to two PCP’s prior to seeking out an Endo on my own. I went to my current Endo for a second opinion on removing the thyroid. Now it looks like I will have to do the same for a Neurologist. I have also seen a rheumatologist who basically ruled out RA, celiac disease, fybromyalgia, and iron overload. I do have djd in knees, mild djd in feet, and start of djd in fingers (determined to be caused by osteoarthritis). My fatigue is becoming somewhat of a challenge, yet I am still relating this symptom to Hashimoto’s and the achiness due to the djd. Do you feel it might be a good idea to rule out MG prior to removing my thyroid? I do not want to make another unnecessary appointment but also do not want an unnecessary surgery. I need help since I cannot find a PCP that will listen to me or that I trust. Your opinion is greatly appreciated.
Unfortunately, many of the endocrine disorders, like thyroid disease, adrenal disease, and parathyroid disease, can mimic myasthenic symptoms. And Hashimoto's symptoms, like myasthenia, can fluctuate over time. But with proper treatment of the low thyroid, you should be able to recover from most of these symptoms.
There is a recognized association between autoimmune thyroid disease and myasthenia gravis. People with autoimmune diseases have higher rates of other autoimmune diseases, so it is quite possible to have myasthenia to boot. But the questions for you and your neurologist would be a) is this myasthenia on top of thyroid dysfunction b) are the symptoms severe enough to discuss symptomatic treatment with pyridostigmine and c) are the symptoms severe enough to discuss immunosuppressant therapy with steroids or other agents. You might need to be tested for myasthenia and you would definitely need a relationship with a physician to discuss this, so I would encourage you to seek out a neuromuscular neurologist.
Hope this helps.
Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati