Thymus gland removal seen as effective option for late-onset MG
Study finds patients who had procedure were more likely to respond to treatment
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- Thymectomy may be an effective treatment option for late-onset MG.
- LOMG patients undergoing thymectomy were more likely to respond to treatment.
- The procedure did not increase surgical complication risks for older patients.
Thymectomy, the surgical removal of the thymus, may be an effective therapeutic option for people with late-onset myasthenia gravis (LOMG) without increasing the risk of surgical complications.
That’s according to a study in China, which also demonstrated that LOMG patients who underwent the surgical procedure were about 2.4 times more likely to achieve treatment response than those treated with medications alone.
The study, “Effects of Thymectomy in Late-Onset Myasthenia Gravis: A Multi-Center Longitudinal Retrospective Study,” was published in Annals of Neurology.
MG is caused by self-reactive antibodies that attack proteins involved in nerve-muscle communication, affecting the muscles that control voluntary movements. Abnormalities in the thymus, an organ of the immune system, are thought to contribute to the production of the self-reactive antibodies that drive MG.
Such abnormalities include thymic hyperplasia (an enlarged gland) or a tumor in the thymus (thymoma). Surgery to remove the thymus may be recommended for MG patients, especially those with a thymoma or with early-onset disease. However, the age limits for thymectomy in MG without thymoma are a matter of debate.
Retrospective analysis compares thymectomy patients with others
The researchers conducted a retrospective analysis of the Clinical Cohort Study of MG, a nationwide, multicenter database. A total of 265 LOMG patients, with a mean age at disease onset of 60.8, were followed for almost four years.
At study enrollment, almost all patients (95.8%) were receiving medications, including prednisone and non-steroid immunosuppressive therapies, with 44.2% receiving both.
Among them, 210 received medical treatment alone, while 55 underwent thymectomy. Those who had surgery were significantly younger than those who were medically treated (56.3 vs. 62). Patients who were younger at disease onset were also more likely to undergo thymectomy.
All patients who underwent thymectomy were matched with 110 patients treated with medications alone, after adjusting for age at disease onset, sex, disease duration, follow-up time, oral medications, bulbar symptoms (such as difficulty swallowing), MG severity, impact on daily life, and coexisting conditions.
The thymectomy-treated group was 2.36 times more likely to achieve minimal manifestation status (MMS) or disease remission. MMS is defined as having no notable functional limitations or symptoms, although some muscle weakness may be present.
Thymectomy also led to a significantly higher treatment response than medications after two years (48.9% vs. 23.8%) and three years (59.5% vs. 28.9%). After five years, the difference remained but was not statistically significant (76.2% vs. 57.9%).
The researchers looked at the adverse effects of thymectomy in 50 patients with LOMG aged 50 and older compared with 49 patients aged 40 to 49. The groups had a similar incidence of adverse events (32% vs. 22.4%), including life-threatening events (10% vs. 8.2%) such as MG crises, in which the respiratory muscles become too weak and ventilatory support is needed.
The “study provides evidence supporting that patients with LOMG can benefit from thymectomy, achieving more favorable outcomes compared to medical treatment alone,” the researchers wrote.
John Pepe
I was 66 years old in 2013 when I was diagnosed with MG. My neurologist said since I was still in good physical condition, even though at that time, people over 60 were discouraged to having a thymectomy, she thought I would do well by having my Thymus removed. Thank you Dr. Raymond. I have been able to do everything I wanted after the Thymectomy. I was a cyclist and rode 70 miles on my 70th birthday. Today at 78 I am still very active playing Pickleball, walking, and riding my bike. (Shorter rides these days). I have been very fortunate and blessed.
Jodi Enders
John, thank you for sharing your experience. Your story adds real-world context to this discussion. While the study focuses on treatment response trends in groups of patients, it's clear that individual outcomes can vary vastly, especially when overall health and activity levels are taken into account. It's encouraging to hear how well you've been able to stay active following your thymectomy. Here is a link to our thymectomy over 50 discussion we have going in the forums if you feel like checking it out: https://myastheniagravisnews.com/forums/forums/topic/thymectomy-above-age-50/. -Jodi, Patient Advocate
Carol Mitchell
I was diagnosed with Myasthenia Gravis in 1988 in Austin. In 1989, my Neurologist in Austin sent me to Houston to a doctor who had done extensive research on MG. It was 2 days before my 50th birthday that I had a thymectomy at Methodist Hospital in Houston which was done like open heart surgery. I was put on IVIG which I could not get in Austin so I was driving to Houston to get it. I had the surgery 2 days before my 50th birthday, and now I am 86 years old. I firmly believe that the surgery was the right thing to do. I still have fatigue when I am stressed. If I do too much or go for days without lots of rest, I suffer fatigue. Energy used can be good stress (excitment) or normal stress. The thing that I hate the most is the fact that I cannot travel without getting totally wiped out. I am thankful that I had the thymectomy because who knows how I might be today without it.
Jodi Enders
Thank you for taking the time to share your experiences and journey, Carol. Your ordeal reflects what the study highlights, that thymectomy can be an option for some people with later-onset MG. Here is a forum discussion about thymectomy over 50 that you might be interested in taking a look at: https://myastheniagravisnews.com/forums/forums/topic/thymectomy-above-age-50/. Your comments about fatigue and pacing are an important reminder that symptom management remains part of life with MG, even when treatment is beneficial. Many readers will likely relate to your perspective on balancing activity, stress, and rest, as well as your situation with travel just being too much for your body to handle. If you are ever considering traveling in the future, here are some helpful resources with advice: https://myastheniagravisnews.com/myasthenia-gravis-travel-tips/, https://myastheniagravisnews.com/columns/travel-with-chronic-illness-3-tips/, https://myastheniagravisnews.com/video/travel-tips-sarah-bendiff/, https://myastheniagravisnews.com/columns/how-mg-changed-way-i-travel/ -Jodi, Patient Advocate