A case of myasthenia gravis with thymoma accompanying graves’disease

症例は50歳代女性.易疲労感を主訴に受診し,精査で胸腺腫を伴う期の重症筋無力症,およびバセドウ病と診断された.重症筋無力症に対する手術前に甲状腺機能亢進症に対する薬物療法を行い,甲状腺機能の正常化を行った後に両側完全胸腔鏡アプローチによる拡大胸腺摘出術を行った.術直後に一時的に洞性頻脈を認めたが,甲状腺クリーゼは認めなかった.また重症筋無力症による術後呼吸筋麻痺やクリーゼは認めなかった.重症筋無力症に様々な自己免疫疾患,特に甲状腺機能亢進症の合併が多いことは知られている.重症筋無力症と甲状腺機能亢進症の病態の密接な関連が知られているが,最善の治療戦略について一定の見解はない.甲状腺機能亢進症の薬物療法後に低侵襲アプローチ下に拡大胸腺摘出術行うことで安全に周術期を乗り切った1例を経験したので報告する.

A 58-year-old female reported to Yamaguchi University Medical Hospital with a complaint of fatigability. After a detailed examination, she was diagnosed as having myasthenia gravis with thymoma accompanying Graves’disease. She underwent extended thymectomy via bilateral thoracoscopic approach after she had achieved euthyroid status through medication. Soon after the surgery, temporary sinus tachycardia was identified, which was not due to thyrotoxic storm. She had no postoperative respiratory muscle paralysis or crisis due to progression of myasthenia gravis. It has been found that myasthenia gravis is often associated with autoimmune disease, especially Graves’disease. However, controversy surrounds the best therapeutic strategy in patients with myasthenia gravis and Graves’disease. Our case suggests that medical control of the hyperthyroidism followed by an extended thymectomy via a minimally invasive approach is a treatment option for patients with combined myasthenia gravis and hyperthyroidism.

重症筋無力症

甲状腺機能亢進症

周術期管理

胸腔鏡下拡大胸腺摘出術