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Myasthenia Gravis

Rethymectomy

11/15/2007

Question:

I had a standard thymectomy for myasthenia gravis 15 years ago.My symptoms improved but extreme tiredness after exercise remains a symptom and recently swallowing difficulties have emerged again.I am considering another procedure to see if any ectopic foci remains which could be preventing complete stable remission.I have read about "maximal" thymectomy at Pub Med and this has given me some hope ,if successful, for a better quality of life.

Do you recommend it?

Answer:

Thymectomy is not a guaranteed cure. And looking for ectopic foci of thymus may have its own complications, especially if not done by a surgeon very experienced in this surgery. If there is a clear thymic mass or thymic tumor (thymoma) or tissue suggestive of thymus, then it seems like it may be useful. Remission after "normal" thymectomy at 7-10 years is 40-60% (except patients with thymoma who have a lower remission rate). I found remission numbers for "maximal thymectomy" to also be in this number range (40-60%). There is data that has shown that thymectomy in patients with disease onset after age 50 have lower remission rates. Some forms of myasthenia, for example the anti-MUSK antibody form, does not always show thymic pathology.

"Maximal thymectomy" means they are looking for ectopic rets of thymic tissue. But the long-term results of this method in the treatment of myasthenia gravis have not been agreed upon in any consensus. Based on your age and other medical conditions, you must discuss the risks with your doctor and the potential benefits. The disease, like the other autoimmune diseases, has quiet periods and active periods. It might not have anything to do with the thymus at this point.

For more information:

Go to the Myasthenia Gravis health topic, where you can:

Response by:

Robert W Neel, IV, MD Robert W Neel, IV, MD
Assistant Professor of Neurology
College of Medicine
University of Cincinnati