[47F] Experiencing transient neurological symptoms post-thymectomy

Patient Description

A 47-year-old female reports transient bilateral eyelid drooping, difficulty swallowing, particularly with solid foods, and slurred speech that began 10 months ago following a thymectomy. These symptoms appear to be exacerbated by fatigue and improve with rest. There is no known diagnosis of myasthenia gravis, which is commonly associated with these symptoms. The patient's medical history is significant for breast cancer, for which she underwent surgery, chemotherapy, and radiation. She is currently managed with Tamoxifen 10 mg and tri-weekly immunotherapy (Kanjinti). No known drug allergies. No other medications reported.

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Arora's Assessment

What might be happening

Based on the symptoms you've described, the following conditions might be considered:

  • Myasthenia Gravis: This is a chronic autoimmune, neuromuscular disease that causes weakness in the skeletal muscles responsible for breathing and moving parts of the body, including the arms and legs. The primary symptoms are muscle weakness that worsens after periods of activity and improves after periods of rest. These muscles may include those that control eye and eyelid movement, facial expression, chewing, talking, and swallowing. Given your history of thymectomy, this condition could be a possibility.

    • Treatment typically involves medications to help improve muscle strength and suppress the immune response.
  • Side effects of your current medications: Both Tamoxifen and immunotherapy can cause various side effects, including muscle weakness and fatigue. However, they are less likely to cause the specific symptoms you're experiencing.

    • Treatment would involve discussing these side effects with your doctor, who may adjust your medication regimen accordingly.

What you can do

Given the nature of your symptoms, it's important to seek medical attention. Here are some steps you can take:

  1. Contact your healthcare provider to discuss your symptoms. They may want to perform certain tests or refer you to a specialist.
  2. Keep a symptom diary. Note down when your symptoms occur, what you're doing at the time, and how long they last. This can help your healthcare provider in diagnosing your condition.
  3. Continue taking your current medications as prescribed, unless advised otherwise by your healthcare provider.

What you should look out for

Please seek immediate medical attention if you experience:

  • Sudden worsening of your symptoms
  • Difficulty breathing
  • Difficulty moving your arms or legs
  • Changes in your vision

Remember, while I strive to provide accurate information, I'm not a doctor. It's important to consult with a healthcare provider for a formal diagnosis and treatment.

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People Also Ask


What is myasthenia gravis and how is it diagnosed?

Myasthenia gravis is a chronic autoimmune neuromuscular disorder characterized by muscle weakness that worsens with activity and improves with rest. It is often diagnosed through clinical evaluation, blood tests for specific antibodies, electromyography (EMG), and sometimes imaging studies.


Can a thymectomy lead to symptoms like eyelid drooping and difficulty swallowing?

A thymectomy, which is the surgical removal of the thymus gland, is sometimes performed in patients with myasthenia gravis. While it can be associated with symptom improvement in some cases, it is not typically known to cause symptoms like eyelid drooping and difficulty swallowing. However, these symptoms can be related to myasthenia gravis itself.


What are the potential side effects of Tamoxifen and Kanjinti?

Tamoxifen can cause side effects such as fatigue, hot flashes, and muscle pain, while Kanjinti (a biosimilar to Herceptin) can cause fatigue, muscle weakness, and other side effects. However, these medications are less likely to cause the specific symptoms of eyelid drooping and difficulty swallowing.


How can I manage symptoms that worsen with fatigue and improve with rest?

Managing symptoms that worsen with fatigue involves balancing activity with rest, avoiding overexertion, and possibly adjusting medications under the guidance of a healthcare provider. Keeping a symptom diary can also help in identifying triggers and patterns.


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