Hi. Yes I've has my vit B6 and Vit B12 levels done. I suffer from anaemia and a few weeks ago there was a suggestion it may be the auto-immune pernicious anaemia caused by B12 deficiency. My levels were low normal though so luckily not. My B6 levels have been low and I am on supplementation not related to my MG though. I have had TB before and am on TB prophylaxis which inhibits uptake of B6. I know lack of these vits can cause peripheral neuropathies. I stand corrected but I don't think slightly low liver functions are anything to be concerned about. It is more the high levels that are a problem. Maybe B can help us on this one? Best of luck with all the tests. I hope they lead to better health!

No AchR antibodies belong in blood, in my opinion. Why does Mayo make it difficult to get treatment. A positive test without SFEMG is definitive.

In general, vitamin supplementation, I've heard explained, is just a way to get expensive urine, and borderline low levels of those two tests usually have no clinical meaning. B6 and B12 are important, and as ange mentioned pernicious anemia is one of the autoimmune diseases that may accompany MG. Before I would take supplements, assuming a problem, I would like to have the actual levels checked and know what is going on. If there is an absorption problem, oral supplementation may not help.
b (not 6 or 12)

ACHR antibody test has these limitations--so the test is not in itself a diagnosis for MG.
Positive results can be found in patients with autoimmune liver disease.
False-positive results may occur in patients with amyotrophic lateral sclerosis.
Patients taking muscle relaxants may have inaccurate results.
Patients who have recently received radioisotopes, therapeutically or diagnostically, may have inaccurate results.
The range of normality is < .02 nmol/L at some labs (Mayo) and up to .05 nmol/L at others.
A positive test ACHR and MG symptoms are diagnostic of MG, not just the test itself.
A negative test is not used to rule out MG, as at least 10-15% of people diagnosed with MG do not have this particular antibody.

That said, if ACHR is negative, yet one has MG symptoms, then the EMG or other antibody tests are done to diagnose MG. Sometimes the diagnosis is done just by symptoms or response to Mestinon when the other tests are inconclusive. If none of the tests are positive; there is poor response to MG meds, and symptoms are mixed, doctors and patients must consider alternatives.

Yes, SGOT and SGPT low can indicate vitamin B deficiency, however the normal range is often stated lower than your tests. Having these high is an indication of liver damage or problems--that is why they are tested. Having them low is good. Some normals for these start at 0 and go up, so worry about them if they are high and be happy they aren't!
Good Luck

Alright Russ, now you're freaking me out a little. People with ALS can have a false positive for MG?? I started with bulbar symptoms in 2007 so I'm hoping if this was ALS they would know. I've never heard of that until now, but I've never looked for it.

Very rare to have ACHR positive and only ALS, but possible.

However more common to have ACHR positive and an auto-immune liver disease. Even might have positive it with polio in one's past. So, the good doctor is checking to make sure your liver tests are good (they are).

Remember, ACHR positive is not quite enough on its own to be sure you have MG--positive with symptoms is the usual criteria, or positive with positive emg etc.

Good Luck

Makes sense. I was checked for RA and had the antinuclear tests. I only have visual evidence of eyelid weakness. Mild pstosis bilaterally. The bulbar symptoms were a bit trickier in the past because I mainly have neck weakness in back, my tongue feels heavy, but sometimes so do my jaw muscles too. I have only been in the ER twice for breathing and the throat issues and it was dismissed as anxiety. This was before I had a any testing for MG. I guess I will need to wait and see. I really hope it IS just MG and that with the proper treatment we can get my vision back on track.

If you have clinical symptoms of MG, a positive test should suffice. The rest in my opinion are a business model.

On my CMP, Comprehensive Metabolic Panel (blood draw):
SGOT is reported - as AST.
SGPT is reported - as ALT.

Here's an example of reported readings, from my own CMP.
Both Ranges are reported in U/L.
The Range for SGOT/AST = 0 - 37.
The Range for SGPT/ALT = 0 - 40.

Here is a Mayo Clinic link, stating that low levels on these tests - are considered normal.
Although - that is a call for your doctors to make.

http://www.mayoclinic.com/health/liver-function-tests/MY00093/DSECTION=why-its-done

I was first diagnosed with MG, approx. 7 yrs ago (At first: drooping eye and eyelid; then AChR test. Back then, I passed both the EMG and SFEMG tests - go figure. The Nincompoop who conducted the EMG & SFEMG tests? Ignored my file & the diagnoses of a fellow neurological associate, and immediately started to schedule me for an appt. with a neuropsychiatrist. The Nincompoop's diagnosis? Anxiety.

My current and longtime Neuro (number 3) , laughed off the Nincompoop, saying: ''Anxiety? Yeah, I'd have anxiety too, if I had as much wrong with me - as you do.''

Getting to the point? You seem well ahead of where I was, in your understanding of MG - and the pack of conditions, often autoimmune - that can run with MG.

Good job!
- Ross
PS: today's up-to-date ultrasound machines can eliminate a lot of possibilities with liver, kidney, and other organs.

Oops.
My SGOT/AST = 24.
My SGPT/ALT = 25.
- Ross

As others mentioned autoimmune pernicious anemia can accompany MG. I was as low as 106. I was then tested for antibodies to parietal cells and antibodies to intrinsic factor. I was positive for both! B-12 deficiency causes neurological symptoms and if not treated can cause permanent damage. For the rest of my life I need B-12 injections because my stomach cannot absorb it. I was hoping that was the end of the story back in 2009 but alas I have MG also.

"Values of less than 200 pg/mL are a sign of a vitamin B12 deficiency. People with this deficiency are likely to have or develop symptoms. Older adults with vitamin B12 levels between 200 and 500 pg/mL may also have symptoms" http://www.nlm.nih.gov/medlineplus/ency/article/003705.htm

My new PCP just told me today he wants my levels up to 600 so that they are good not just low normal! Yay for a PCP that strives for wellness not just borderline okay!

You might want to ask for the B-12 blood test Strizzlow. it's an easy test for the lab. Good Luck!
Aloha,
Marina

The SGOT and SGPT tests are not direct liver function tests, but are part of a liver panel to detect tissue damage. It is concerning when levels are high, but as far as I know not if they are slightly low. I have seen low ALT/AST levels in patients, but I can't recal it ever being clinically significant. Vitamin B6 deficiency is not common here, but I have seen it a couple times in severely malnourished people (anorexia) and many times in alcoholics. Usually chronic alcohol use would make the liver function tests swing the other way, though. Usually the reference values for normal vary from institution to institution, also. Since you are so close to the reference range, your values may be normal fory ou.

Thank you for your experiences and knowledge on this. i saw online where 0 was considered normal so im probably good. My b12 is good at around 670. i checked out russ' info in als and sure enough false positives can occur.

Although a lot of modern medicine seems to rely on testing (probably because it is quicker and easier to report to insurance companies), the test are not the whole story and history and physical are important elements when it comes to differential diagnosis. You need a good doc to put together the pieces, not a list of possibilities from testing the general population of "normals" and patients with various diseases. We can all google up the lists.

It is not like you and your doctors have never considered those possibilities, or you need any encouragement or threat to get medical treatment. I hope it will be a productive visit and you will get the answers and treatment you need (not just more testing)!! b.

I agree with B about the testing.

I recently cancelled an appointment for an EMG test the a "Specialist" ordered after asking "Will the results change my diagnosis? Will my treatment plan be changed based on the results? "Why are we doing this test?"
When I was told that it was simply to "check for remission and see how you are doing" I told them "Well I can tell you that myself!"
Testing is not fun for me, and I won't do it unless I feel I need an answer from the test!
You know your body!
Love, Becca