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Concurrent Myopathy in Patients with Graves’ Orbitopathy

The extraocular muscles may be affected by various disorders, including inflammatory myopathy, myotonic dystrophy, mitochondrial disease, vitamin E deficiency and neoplasia (Kaminski et al., 2002; Schoser & Pongratz, 2006). The distinct properties of the extraocular muscles compared to other striated muscles–a more complex myosin expression, higher metabolic rate, and a higher maximum firing frequency–explain their frequent involvement in conditions such as myasthenia gravis, chronic progressive external ophthalmoplegia (CPEO), and Graves’ orbitopathy (GO) (Yu Wai Man et al., 2005). The clinical spectrum of these various myopathies are diverse. This report describes four patients whose extraocular muscles were affected by more than one disorder simultaneously. The concurrence of GO and a specific neuromuscular disorder seems extremely rare, but may be underreported.