When is thymectomy indicated in the treatment of myasthenia gravis (MG)?

Updated: Aug 27, 2018
  • Author: Abbas Jowkar, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

An extended trans-sternal thymectomy is standard of care and is indicated for all patients with thymoma and for patients aged 10-55 years without thymoma but who have generalized MG. Patients with thymomas almost always have anti-AChR-ab and so one must look carefully for thymoma in late-onset patients with anti-AChR-ab positive status. Removal of thymoma is essential to prevent local dissemination and systemic metastases. In late onset patient with MG and thymoma, thymectomy probably does not change the course of MG. Thymectomy has been proposed as a first-line therapy in most patients with generalized myasthenia. [52]  In patients who have myasthenia gravis like symptoms but who are seronegative order a CT of chest regardless, to check for thymic pathology, since a small percentage of these patients may subsequently seroconvert to anti-AChR-ab positive status.

In ocular MG, thymectomy should be delayed at least 2 years to allow for spontaneous remission or the development of generalized MG. Whether thymectomy is to be performed for prepubescent patients or patients older than 55 years is still controversial. Reports tend to encourage surgical treatment for the latter group.


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