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“If it looks like a duck, swims like a duck, and quacks like a duck, then it probably is a duck. Sure sounds to me like it’s MG. You are correct that the antibody level cannot be used to determine the absence or severity of MG, because of the incredibly dynamic interaction between the antibodies and the NMJs.
I continue to have a huge question over any possible correlation between the nicotinic acetylcholine receptor antibodies that is a hallmark of MG and the possibility that there could also be antibodies to muscarinic acetylcholine receptors that are used in the autonomic nervous system, which could potentially be a significant cause for dysautonomia symptoms. The autonomic nervous system is in charge of cardio, gastro, pulmonary and other body systems.
I also believe that auto-antibody mediated autoimmune diseases should be viewed as a spectrum disease, where symptoms depend on the particular auto-antibody the immune system has mistakenly started generating. In fact, many treatments for different AI diseases are remarkably similar. Daughter has drastically improved undiagnosed symptoms unrelated to her MG diagnosis (like gastroparesis) once she started getting some real MG treatment.
Energy, particularly glucose, is needed to manufacture auto-antibodies. When the immune system has gone on the warpath attacking the body with auto-antibodies, it’s guzzling glucose, and I suspect depriving the brain and body of glucose, hence fatigue may be a direct correlation of how active an immune attack may be.