Jack, I'm sorry you're having more problems. I think it's a good idea to see your primary doctor to have them order a few tests, like thyroid, B12, vitamin D (even though you're taking it), etc.

For the sake of that conversation, you should probably keep a journal for a few days. Are you weak or sleepy tired? Fatigue is one of those words in medicine that is not specific enough! It's used for a lot of conditions.

Endocrine issues can make you more tired and more weak. So can a B12 deficiency. That's why seeing an internist is the best thing to do. They "generalize" instead of "specialize" and can try to help you figure out if it's just MG or something else making MG worse.

As far as the drugs go, really do your research on them! The problem with taking more than one drug at a time is that you don't know which one is making you better - or worse. And then it's also hard to tell which one is causing side effects. Even with supplements, it's best to try one at a time.

If you do have a vitamin D deficiency, it would cause things like neuromuscular pain, hair falling out, etc. And if you do have one, you need to take it daily and have the dose directed by your primary doctor. 1000 IU's may not be enough. I take nearly 5000 daily and my Vit. D is barely above normal.

You'd be amazed at how common a B12 deficiency is. Please get that level checked. If it's on the low end of the range, you should probably supplement with sublingual methylcobalamin (B12). We need B12 to make acetylcholine. So if you're running low on that, it affects both the muscle weakness and alertness.

I hope you'll figure out what's best for you.

Annie