Living with an autoimmune disorder like myasthenia gravis (MG), you may notice times when you feel better and times when you feel much worse. When symptoms like muscle weakness, drooping eyelids, or double vision become more severe, it’s called a flare-up. (Flare-ups are different from a myasthenic crisis, which may cause life-threatening shortness of breath and requires emergency treatment.)

Several factors can trigger symptom flare-ups in myasthenia gravis. Identifying your specific triggers can help you manage your condition better. Once you know what causes your flare-ups, you can take steps to avoid them. This process may require some trial and error.

Here are some common triggers to pay attention to. Many of them can be avoided to help keep symptoms under control.

1. Stress

Stress can trigger myasthenia gravis flares, leading to increased muscle weakness. When stressed, your muscles tense up — similar to the effects of strenuous exercise — leaving them extra weak.

Some members of MGteam have observed this correlation. “I have noticed that there is a correlation between stress events and MG problems,” one member reported.

If stress affects your MG symptoms, managing that stress can help. As one MGteam member said, “My top priorities in lifestyle adjustments were to identify stressors and positively modify them to remove stress.”

For some people, managing stress may start with accepting the new normal of life with myasthenia gravis and asking for support when it’s needed.

2. Surgery

Having any sort of surgery can also worsen myasthenia gravis, though health experts aren’t sure why. A member of MGteam who experienced this said, “Been struggling this week with MG. … Don’t know if this surgery I had has set me back.”

If you need surgery, inform all your doctors about your myasthenia gravis. They can help you weigh the pros and cons and create a plan to manage potential symptoms. Similarly, for dental procedures, ensure your dentist or oral surgeon is familiar with myasthenia gravis and its treatments.

3. Infection

Some infections can also worsen myasthenia gravis symptoms. This response is not tied to any specific types of infections but is a common trigger among MGteam members. One member, after developing a urinary tract infection (UTI), reported, “My MG symptoms creeped up again!”

Another added, “I had one myasthenic crisis 14 years ago due to an infection.”

To help prevent infections, consider getting regular immunizations. However, consult your MG specialist first, especially if you’re on immunosuppressive medication, as you may need to avoid live vaccinations — that is, vaccines that use a weakened form of the virus or bacteria to stimulate an immune response.

Follow standard advice to avoid infections, too. This means:

• Washing your hands frequently with soap and water
• Not sharing drinks or food with others
• Making sure the people around you cover their coughs and sneezes effectively
• Wearing a face mask to reduce the chance of infection, especially in crowded or enclosed spaces

If you’re particularly worried about an infection, stay home and avoid other people. This is the only sure way to avoid getting sick.

4. Allergic Reactions

People with allergies are more likely to develop myasthenia gravis. It makes sense that allergies might also trigger flares because they are an immune response, and anything that disrupts the balance of the immune system can cause an autoimmune-disease flare.

If you know what you’re allergic to, the best way to avoid worsening myasthenia gravis symptoms is to avoid those allergens as much as possible. Ask your MG specialist if you should also take antihistamines (medications to control your allergies).

5. Pregnancy

Pregnancy causes many changes throughout the body. In some people, it can worsen myasthenia gravis symptoms, while others may experience remission (disappearance of symptoms) during pregnancy.

If you’re pregnant, make sure you know when to call your doctor. Contact them if your symptoms worsen. If you have trouble breathing, you may need urgent medical help to ensure both you and your baby stay healthy. Don’t hesitate to reach out, even if you aren’t sure you need help. It’s better to ask for help when you don’t need it than to not ask in an urgent situation.

6. Certain Medications

A variety of medications can worsen myasthenia gravis symptoms. These include medications for:

• Heart arrhythmias
• Malaria
• High cholesterol
• Bacterial infections
• Cancer

These are just a few types of medication that can exacerbate myasthenia gravis. Ensure that any doctor prescribing medications for you knows about your MG diagnosis. They should prescribe medications that do not trigger your symptoms and may need to consult with your neurologist for further discussion.

Sometimes, you may need to take a medication that could worsen myasthenia gravis. In these cases, you and your health care provider will need to weigh the pros and cons. Consult with your neurology team before deciding whether to try the medication. If you do try it, have a plan in place for what to do if your symptoms worsen.

7. Treatment for Thyroid Disease

In people diagnosed with both myasthenia gravis and an overactive thyroid, treating the overactive thyroid can worsen myasthenia gravis. Researchers believe this happens due to the effects of thyroid medications on the immune system.

If you have both conditions, consult your doctor before pursuing any treatment. Your doctor may proceed more cautiously or seek a treatment option less likely to worsen myasthenia gravis symptoms. They can also help you develop a plan in case your myasthenia gravis worsens.

8. Heat

Being too warm may cause your myasthenia gravis to worsen. Higher temperatures make it harder than usual for muscles and the brain to send signals back and forth. Since people who live with myasthenia gravis already have problems with these systems, being warm can make it even worse. One MGteam member who experienced this said, “I’m trying to stay inside to beat the heat, which is not a friend anymore.”

Another shared, “I guess a hot shower takes me down the fatigue road.”

If heat makes your condition worse, do everything you can to stay cool, including:

• Using your home’s heating, ventilation, and air conditioning (HVAC) system to keep temperatures low
• Taking shorter and/or cooler showers
• Drinking iced beverages instead of hot ones
• Limiting your physical activity so you don’t overheat

In short, take whatever steps you need to take to avoid getting too warm.

Talk With Others Who Understand

MGteam is the social network for people with myasthenia gravis and their loved ones. Members come together to ask questions, give advice, and share their stories with others who understand life with myasthenia gravis.

What makes myasthenia gravis symptoms worse for you? What have you found that brings relief? Share your experience in the comments below, or start a conversation by posting on your Activities page.