Hi, and welcome. The following is just how I understand it--there are some knowledgeable people here who will correct me if I'm wrong.

Mestinon works, as you know, by inhibiting acetylcholinesterase, the enzyme that breaks down acetylcholine. But there's only so much that Mestinon can help--not because it doesn't inhibit the enzyme enough, but because if your neuromuscular junctions are under attack, having acetylcholine hang around longer can only do so much. It allows your good receptors to do double duty, but it doesn't fix the bad ones.

TCH may be an acetylchlinesterase inhibitor like Mestinon, though I've never heard that. There's also one of those "natural supplements" that inhibts acetylcholinesterase (huperzine). But if Mestinon alone isn't enough, TCH and huperzine won't help. If Mestinon is doing its maximum, then more drugs that have the same function won't increase the benefit--and they might be dangerous, since too much acetylcholine in your system can cause a cholinergic crisis, which is life-threatening.

Hope that makes sense. I hope that the fact that you've been in remission twice means that you'll go into remission again--and soon! Besides MG, I have Graves' disease (autoimmune hyperthyroidism) and I've had a series of remissions, each one lasting longer than the last. I don't know if MG is like that, but for your sake, I hope so!

Abby