Closed

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.

Select Relevant Investigations
anti-AchR & anti-MuSK abs

Performed

anti AchR-abs: positive
anti MuSK-abs: positive
Repetitive Nerve Stimulation

Performed

There is an 18% decrement in compound muscle action potentials over time.
TSH + FT4

Performed

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

Performed

The MRI of the thorax shows no mediastinal masses.

Select Relevant Management
Endocrinology Referral
Oral Pyridostigmine
Thymectomy
Pneumococcal Vaccination