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Myasthenia gravis: Suspect-and-test checklist for clinicians

A one-page worksheet that turns the full Myasthenia gravis diagnosis guide into something you can use at the point of care: what to look for, what to order, which results should not end the workup, and who else to test or refer.

Who it is forClinicians and care teams who may see Myasthenia gravis before it is diagnosed, including primary care, the specialists named in the guide, and referral or genetics coordinators.
When to use itWhen Myasthenia gravis is on the differential, when a patient has several red flags, or when you are preparing a referral or a second opinion.

How to use it, section by section

  1. Red flags present: Tick each finding the patient has. They are grouped by body system so you can scan quickly.
  2. Already labeled as: Tick earlier diagnoses on the chart that the sources say are often given first.
  3. Family to test: Note relatives who may need testing, and record when symptoms began and which specialists have already been seen.
  4. Testing, in order: Tick each test as you order it and write the result on its line. The order follows the published sources.
  5. Results that do not rule it out: A reminder of findings that can look reassuring but do not exclude Myasthenia gravis.
  6. Specialists: Tick the referral, then write who it went to and any notes.
Two ways to fill it inPrint it blank and write on it, or tick boxes and type on this screen first, then print or save as a PDF. Keep it with the chart or send it with the referral.
PrivacyNothing you type is sent or saved. It stays in this browser tab and disappears when you close it. Use patient initials, not full identifiers.

What it is not: Not a diagnostic score, a protocol or coding advice. It summarizes published sources, and clinical judgment and the treating clinician govern. Every point is sourced in the full Myasthenia gravis guide.

One Letter page. Use your browser's print or save as PDF.Full guide with sources
Suspect-and-test checklist
Myasthenia gravis

Autoimmune neuromuscular junction disease. Weakness fluctuates and fatigues, and a negative antibody test does not exclude it.

ICD-10-CMG70.00, G70.01Trial Friend for Clinicians

1Red flags present

Eyes

Speech, swallowing and voice

Limbs, neck and breathing

Older adults and new drugs

Impending crisis

2Already labeled as

3Family to test

4Testing, in the order the sources describe

  1. Ice pack test for ptosisSensitivity 86%, specificity 79% in 155 patients. Not the primary test, per Israel's guideline.
    Result
  2. AChR binding antibodyFirst test, per Israel's guideline. Positive in up to 85% of generalized and about 50% of ocular disease.
    Result
  3. MuSK, then LRP4 antibodyMuSK if AChR negative; LRP4 in selected double seronegative cases.
    Result
  4. Cell-based assays; repeat serologyLive assays found clustered AChR antibodies in 4.5% to 19.5% of seronegative patients. A 2021 review says testing may be repeated within 6 to 12 months in selected cases.
    Result
  5. Repetitive nerve stimulation, single-fiber EMGDecrement above 10%. Jitter is most sensitive but not specific.
    Result
  6. Chest CT or MRIThymoma check for every patient, per the German guideline. Thyroid function tests in definite or probable cases, per a 2021 review.
    Result
  7. Antibody type on drug labelsLabels: Vyvgart any adult gMG; Rystiggo and Imaavy AChR or MuSK; Zilbrysq AChR only.
    Result

5Results the sources say do not rule it out

  • Negative AChR antibody. About half of ocular cases test negative.
  • Stroke changes on brain imaging in an older adult. Incidental findings have misled.
  • Negative ice pack test alone. Both ice pack and single-fiber EMG negative gave a 94% negative predictive value.
  • A positive ELISA antibody with an atypical picture does not settle it. Overdiagnosis also occurs.

6Specialists the sources name

Diagnosis codes: G70.00 Myasthenia gravis without (acute) exacerbation; G70.01 Myasthenia gravis with (acute) exacerbationCodes patients often carry before diagnosis are listed in the online guide.
Full guide and sourcesEvery point here is sourced in the online guide, which also has a patient note to print.
Trial Friend, trialfriend.com/for-clinicians. Key sources: 2016 international consensus guidance; 2020 international consensus update; German guideline (2023); Israel national guideline (2025); Gulf consensus (2025); Rousseff 2021 diagnostic review; all 48 with links in the online guide. Checked November 11, 2026. A reference checklist for licensed clinicians that summarizes published sources. It is not a diagnostic tool, a score or a protocol, and it does not replace clinical judgment, local practice or the prescribing information. Not coding advice. Trial Friend never receives anything written or typed on this sheet.