A 32 year old female patient came to see me a fortnight ago with complaints of diplopia of 10 days duration. She had gone to an ophthalmologist in her city and was prescribed glasses with prisms to counter the double vision.This was the history given to me before I saw her.
But it was a spotter when she walked into my clinic at ASH. One look it was MG,myasthenia. I did put her on tablet pyridostgamin 60 mg twice a day since she was quite symptomatic and her ptosis was gross. She was here just for a day and I asked her to see a neurologist in her city immediately on getting back which she did.She was investigated, serum anticholinesterase antibody test,CT for thymoma and EMG studies. The first two were negative. She has been continued on pyridostigamine.Her diplopia and ptosis have improved considerably but continues to use the prism glasses.She has been in constant touch with me.
Now it appears that her myasthenia both systemic and ocular, possibly ocular was not the first presentation, going by the symptoms she had had the preceding 6 months and most of which had abated after the start of treatment.
Now the questions are
1 Does she undergo thymectomy immediately since she is only 32
2 Her diplopia has not gone as yet. Whether she should also be put on steroids or should that be thought of after thymectomy
3 Any other points to look at.