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Pyridostigmine & The 1990-1991 Persian Gulf War Syndrome Because pyridostigmine is a highly ionized quaternary ammonium compound, under normal conditions it does not readily cross the blood-brain barrier (BBB) (Dunn et al, 1997

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The most common suspected adverse event reported was subacute thyroiditis, followed by Graves disease with other incidental reports of painful thyroiditis, silent thyroiditis, concurrent Graves disease and subacute thyroiditis, thyroid eye disease, overt hypothyroidism, atypical subacute thyroiditis, and painless thyroiditis with thyrotoxic periodic paralysis (133)