{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:37:38Z","timestamp":1787017058340,"version":"build-2736575974"},"reference-count":27,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2017,7,15]]},"abstract":"<jats:p>We present two patients with Graves\u2019 disease and concurrent myasthenia gravis. The impact of the dual diagnosis on the clinical course and the potential for a delayed diagnosis of myasthenia gravis is discussed. Patient 1, a 28-year-old man was diagnosed with Graves\u2019 disease following his second respiratory arrest. His history was strongly suggestive of a second pathology. Patient 2, a 66-year-old Cantonese woman with established Graves\u2019 disease presented with thionamide-related neutropaenia. Examination revealed bilateral ptosis and right lateral rectus palsy. Both patients had thyrotoxicosis secondary to Graves\u2019 disease with concurrent myasthenia gravis. Although neuromuscular weakness is common in Graves\u2019 disease, coexisting myasthenia gravis (MG) is rare and can cause profound morbidity. Ocular signs in both diseases may cause diagnostic confusion although ptosis suggests coexisting MG. In both cases, the thyrotoxicosis delayed the diagnosis of MG.<\/jats:p>","DOI":"10.1136\/bcr-2017-220153","type":"journal-article","created":{"date-parts":[[2017,9,7]],"date-time":"2017-09-07T06:42:50Z","timestamp":1504766570000},"page":"bcr-2017-220153","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Hickam's dictum: Myasthenia Gravis presenting concurrently with Graves' disease"],"prefix":"10.1136","volume":"2017","author":[{"given":"Shekhar","family":"Sehgal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roshan","family":"Rebello","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Wolmarans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0748-2300","authenticated-orcid":false,"given":"Marianne","family":"Elston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,9,7]]},"reference":[{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.1","doi-asserted-by":"crossref","first-page":"2594","DOI":"10.1056\/NEJMcp0801880","article-title":"Graves' disease","volume":"358","author":"Brent","year":"2008","journal-title":"N Engl J Med Overseas Ed"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2007.01313.x"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.3","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.5538.451"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.4","doi-asserted-by":"publisher","DOI":"10.4065\/80.1.99"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.5","doi-asserted-by":"publisher","DOI":"10.1159\/000279334"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.6","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1111\/j.1600-0404.2012.01693.x","article-title":"Clinical features of myasthenia gravis patients with autoimmune thyroid disease in Taiwan","volume":"127","author":"Chen","year":"2013","journal-title":"Acta Neurol Scand"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.7","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine1962.26.2"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.8","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70063-8"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.9","doi-asserted-by":"crossref","first-page":"101","DOI":"10.3904\/kjim.2010.25.1.101","article-title":"Myasthenia gravis presenting as isolated respiratory failure: a case report","volume":"25","author":"Kim","year":"2010","journal-title":"Korean J Intern Med"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.10","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.65.4.492"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.11","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1089\/thy.2000.10.799","article-title":"Increased frequency of euthyroid ophthalmopathy in patients with Graves' disease associated with myasthenia gravis","volume":"10","author":"Marin\u00f2","year":"2000","journal-title":"Thyroid"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.12","doi-asserted-by":"crossref","first-page":"153","DOI":"10.4103\/0976-3147.165393","article-title":"Neurological manifestations of graves' disease: a case report and review of the literature","volume":"7","author":"Mangaraj","year":"2016","journal-title":"J Neurosci Rural Pract"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.13","doi-asserted-by":"crossref","first-page":"73","DOI":"10.4103\/0973-0354.129734","article-title":"Ocular myasthenia with thyroid associated ophthalmopathy in subclinical Graves' disease: diagnostic challenge and treatment outcomes","volume":"11","author":"Biswas","year":"2014","journal-title":"Thyroid Res Prac"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.14","doi-asserted-by":"publisher","DOI":"10.1007\/s00455-001-0114-4"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.15","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.65.6.848"},{"key":"2025042712365842000_2017.sep06_1.bcr-2017-220153.16","first-page":"43","article-title":"Reverse 'see-saw' relationship between Graves' disease and myasthenia gravis; 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