Hyperphoria, MG?

46 year old male.  I noticed first symptom, Hyperphoria (about 2 degrees), about 3 months ago (gradual onset).  I can pull my vision images together but my eye muscles are sore by the end of the day.  I wake with the same amount of Hyperphoria as when I go to sleep (not affected by rest).

One week ago the following started: itchy tingle in hands and feet (mostly palms and bottom of feet).  Sometimes tingle is like small cold spots.  When tingles occur, movement of the affected area stops the tingling.  Hands feel puffy and stiff (not visually puffy).  Knees ache when climbing stairs; ache like I haven

[CCF-Neuro-M.D.-JT]

Myasthenia is certainly a consideration with the eye symptoms and generalized weakness that resolves with rest. Thyroid problems are also a possiblity (can cause eye problems too) and can easily be checked with blood test. Finally, there are other muscle disorders that could be causing your symptoms, although your ??"muscle enzyme test" was reportedly normal making this less likely. Besides the EMG, other tests that should be considered by the neurologist include routine blood work with thyroid studies, a tensilon test in which a test dose of myasthenia medication is given IV in the office and then you're checked for imporvement in the 1st few minutes afterwards, and myasthenia antibodies in blood. There are other disorders that can look like myasthenia such as botulism (you'd be much sicker) and disorders related to cancer, especially lung cancers (but you say you don't smoke.) The neuro appointment is the right way to go. Best of luck,