甲状腺相关眼病合并重症肌无力12例临床分析

Clinical analysis of thyroid associated ophthalmopathy with myasthenia Graves in 12 patients

目的 总结甲状腺相关眼病（TAO）合并重症肌无力（MG）患者的临床表现.方法 回顾性系列病例研究.收集核工业四一六医院眼科2012年10月至2014年2月间就诊的12例甲状腺相关眼病合并重症肌无力患者的临床资料.所有患者均详细记录病史、发病情况、矫正视力、眼前后节情况、眼球突出度、眼睑位置、眼球运动、复视、斜视、全身症状等,并行疲劳试验、新斯的明试验、甲状腺功能及眼眶CT检查,1例患者行胸腺CT检查.结果 12例TAO合并MG患者中,女性8例,男性4例,患者年龄13.0～44.0岁,年龄中位数26.5岁.自觉睁眼困难伴晨轻暮重11例,12例均不伴有全身症状;出现上睑下垂9例,其中双侧受累3例,单侧受累6例;出现眼球运动障碍8例,均为双侧受累,16只眼中,下转受限15只眼,上转、外转、内转均受限14只眼,眼球固定4只眼;12例患者出现复视4例,斜视3例,其中外斜视2例.眼眶CT示肌肉增粗6例,12只眼中累及下直肌12只眼,内直肌及上直肌均6只眼,外直肌3只眼.结论 TAO合并MG临床表现复杂多样,当出现上睑下垂、与TAO病情程度不相符合的眼球运动障碍、外斜视甚至全身肌肉麻痹等症状时,需考虑合并MG可能.

Objective To summarized the clinical features of thyroid associated ophthalmopathy patients with myasthenia gravis.Methods This is a retrospective case series study.The clinical data of 12 thyroid associated ophthalmopathy patients with myasthenia gravis were collected in the 416 Hospital of Nuclear Industry from Oct.2012 to Feb.2014.All patients had a detailed medical history including symptoms of onset,the best corrected visual acuity,anterior and posterior segment examination,the exophthalmos,eyelid position,eye movement,diplopia,strabismus,systemic symptoms,concurrent fatigue test,neostigmine test,thyroid function and orbital CT scan.One patient underwent CT examination of thymus.Results In all 12 patients,there were 8 females and 4 males with age from 13.0 to 44.0 years （the median age of 26.5 years）,11 cases had difficulties to open their eyes which was least severe in the morning and worsened in the evening.All of cases did not have general symptoms.Ptosis was observed in 9 cases,3 cases were bilateral,and 6 cases were unilateral.Abnormal extra ocular muscle function was observed in 8 cases,all of them were bilateral.In these 16 eyes,the limitation of downward gaze were observed in 15 eyes,the limitation of upward,outward and inward gaze were observed in 14 eyes,eye fixation occurred in 4 eyes.Four cases had diplopia,3 cases had strabismus,and 2 of them were exotropia.Orbital CT demonstrated extraocular muscle thickening in 6 cases.Thickening of inferior rectus were observed in all 12 eyes,superior rectus and medial rectus were found thickened in 6 eyes,and thickening of lateral rectus muscle was found in 3 eyes.Conclusions The clinical features of thyroid associated ophthalmopathy patients with myasthenia gravis were complex.When ptosis and eye movement disorders were not consistent with TAO severity,associating with exotropia and systemic muscle paralysis,myasthenia gravis should be considered.