Myasthenia Gravis

[Ciara02]

Can someone help, my right eyelid has been drooping lately and it's more noticeable at night. At first my eye just felt gritty and I kept rubbing it but when I looked in the mirror it was hanging lower than my left one - which was causing the gritty feeling. I have been getting a heavy feeling at the outer edge of my eyelid, too.
I got in touch with an autoimmune helpline and they said I could possibly have Myasthenia Gravis. They advised me to do the ice test, where I needed to put some ice wrapped in a cloth on the closed eye to see if it would made the eyelid droop and the only things I noticed were that my right eye seemed to close up a bit more and was slower opening fully. I was tested positive for ANA and TPOab, just wondering if there is a connection at all?

Rheumatoid Factor - 9IU/mL (<20IU/mL - negative)

HEP2 - Positive
Type - Speckled

Anti-DS DNA - 7IU/mL (<30IU/mL - negative)

(Positive anti-nuclear antibodies but no significant disease association found)

ENA Screen - Negative

Autoimmune Profile

Anti-Nuclear Abs - Positive
Anti-Smooth muscle Abs - Negative
Anti-Parietal Abs - Negative
Anti-Mitochondrial Abs - Negative
Anti-LKM Abs - Negative
Anti-TPO Abs - Positive (<34)

(Positive anti-nuclear antibodies but no significant disease association found)

[Ciara02]

I have been on Levothyroxine since May of last year but I've had my dose changed so many times and at other times it has been stopped by the doctor. It wasn't until this year that I had my TPOab levels checked.

24 hr cortisol results are below and include DHEA:

Cortisol Levels

Sample 1 (post awakening) - 14.8 (12-22)
Sample 2 (+ 4-5 hours) - 3.9 (5.0-9.0)
Sample 3 (+ 4-5 hours) - 8.9 (3.0-7.0)
Sample 4 (prior to sleep) - 2.0 (1.0-3.0)

Total Daily Cortisol - 29.6 (21-41nmol/L)

DHEA Levels

Sample 2 (am) - 0.16 (sorry no range given but the printout says this result is in the outside range)
Sample 3 (pm) - 0.18 (sorry no range given for this either but the printout says this result is in the outside range)

DHEA : Cortisol Ratio - 0.57 (2.0-6.0)

DHEA Mean - 0.17 (0.40-1.47)

Adrenal Stress Stage - "Resistance Stage 3 - Maladaptation: This generally reflects the "pre-exhaustion or pre-adrenal fatigue" states. Usually DHEA levels fall before cortisol levels are reduced. This is often as a result of an inability to balance chronic stressors or poor adaptation to intensive acute stressors. This pattern would indicate a state of long term stressors depleting adrenal reserves. Stress analysis and adrenal support and restorative measures are exceedingly important. A recheck in 1 month is also strongly advised.

Deviations from the normal cortisol rhythm - "The noon cortisol is below the normal range. Noon cortisol levels may be a good indicator of adaptive adrenal gland function since they represent the adrenal glands' response to the demands of the first few hours of the day. Low noon cortisol levels suggest a degree of adrenal hypofunction with decreased adaptive response.

Deviations in DHEA production - "Decreased DHEA levels may be seen in thyroid disorders, cardiovascular disease, obesity, reduced immunity, rheumatological diseases, and excess cortisol production, or with administration of pharmacological doses of glucocorticosteroids. Low levels are indicative of a lowered capacity to endure physiological or psychological stress/trauma/injury and may present with abnormal immune response with increased incidence of autoimmune disease."

Thyroid results from November:

TSH - 7.4 (0.2-4.2)
Free T3 - 4.3 (3.9-6.7)
Free T4 - 14.7 (12-22)

That was when my Levothyroxine was moved up.

The comments the lab has put don't sound promising but is it likely the thyroid medication would have caused that?

[TheLightSeeker]

Yes please post the 24H cortisol results. Please include lab reference ranges.
Your TPOab was likely the determining factor for prescribing the Levothyroxine.
You were not given any explanation for this???

Hashimoto's is A/I Hypothyroidism-the majority of sufferers of hypothyroidism have hashimoto's- and should your temperature be consistently below 36.6 Celsius or averaged out lower than 36.6 Celsius, then there's a great likelihood that your thyroid function is low & under-regulated if you are on thyroid meds, or low & unregulated when not on thyroid meds .

Your doctor should monitor your thyroid levels and symptoms carefully and  then make adjustments to your dose accordingly.

I'll comment again when I see your cortisol results.

Take care.
Niko

[Ciara02]

Hi there, thanks for your reply. I am taking Levothyroxine at the moment for hypothyroidism but that was after the TPOab diagnosis was made. Would I have Hashimoto's if I am hypothyroid?

I did basal body temperatures before and my body temp first thing in the morning is never above 35 degrees Celsius.

I don't know what my ANA titre is, it just says on the printout that I was tested positive for it.

I have done a 24 hour cortisol test. If you'd like the results of this I can post them but I don't know what any of it means.

[TheLightSeeker]

Hashimoto's disease should be ruled out as it could be associated with MG.

Your positive anti TPO Abs -(TPO=Thyroid Peroxidase, an enzyme necessary for the signalling Thyroid hormone production) indicates an immune system response against the TPO in the Thyroid.

BTW, what was your ANA titre ?

MG is commonly associated with other Autoimmune conditions
and should you have hashimoto's indeed, it would likely exasperate MG symptoms.

So my opinion is to pursue a hashimoto's diagnosis as well at this point.

On your own meanwhile you can do Dr. Barnes Basal Temperature Test
for thyroid function. Just look it up and follow the simple online instructions
precisely.

If you need more details, let me know, however, please note that my comments and suggestions here are not intended to replace medical advice.

Best wishes.
Niko