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Myasthenia Gravis


Step 1: View clinicals

A 34 year old woman presents with a drooping left eyelid for 1 day. She also experienced difficulty in speaking, swallowing and keeping her head up. The symptoms become progressively worse during the course of the day. Close questioning reveals a history of several episodes of drooping of an eyelid with blurred vision over the past 2 years, with varying intensities. Her medical history is otherwise unremarkable, and she is not on any drugs.

Step 2: Order all relevant investigations

anti-AchR & anti-MuSK abs

anti AchR-abs: positive anti MuSK-abs: positive

Repetitive Nerve Stimulation

There is an 18% decrement in compound muscle action potentials over time.


TSH: 0.2 mIU/L (0.3 – 3.0) FT4: 20 pmol/L (8 - 27)

MRI Thorax

The MRI of the thorax shows no mediastinal masses.

Step 3: Select appropriate management

Endocrinology Referral
Oral Pyridostigmine
Pneumococcal Vaccination

Score: ★★☆