engleski

Myasthenic crisis as a side effect of methimazole therapy ; a case report

Myasthenia gravis and Graves' disease are two autoimmune diseases with a similar mechanism, both having circulating organ auto antibodies and cell specific auto antibodies. It is not unusual for those diseases to appear together. There are many data proving that antithyroid drugs, as methimazole and propylthiouracil, have an immunomodulatory effect in addition to their thyreosuppressive action. This case report describes a 34-year-old woman hospitalized for only just diagnosed myasthenic crisis (Osserman IV). She has had prior history of hyperthyroidism and started treatment with methimazole. However, improvement of thyroid disease led to burst of myasthenia. The phenomenon described as worsening of one disease while improving the other, a so called “see-saw relationship”, happened in this case. Question is weather antithyroid drugs improve hyperthyroidism while unveiling or worsening myasthenia. Is the see-saw relationship actually a therapeutic side effect of antithyroid drug? Proposed mechanism of methimazole action is intracellular: it lowers the level of proliferating cell nuclear antigen (PCNA). PCNA promotes selective apoptosis in some T lymphocytes clones. That’s way CD4+CD25+ regulatory T cells might "skip" immune self-tolerance and possibly auto antibodies against acetylcholine receptor occur. Do antithyroid drugs actually create an immune "thymic surrounding"?

myasthenia gravis; hyperthyroidism; antithyroid drugs; autoimmune disease

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