Thymectomy is one of the main treatment methods for myasthenia gravis. It is a surgical procedure where the thymus gland is removed to stop the production of autoantibodies that mistakenly attack the muscle-nerve connections in myasthenia gravis patients.
How thymectomy helps myasthenia gravis patients
The thymus is a small gland in the upper chest, under the breastbone. It is an important part of the immune system in children but becomes redundant in adults. Removal of this gland is thought to interfere with the production of autoantibodies.
A thymectomy is commonly performed in patients who develop a mostly benign and slow-growing tumor in the thymus, called a thymoma. This type of tumor occurs in 15 percent of myasthenia gravis patients. But the procedure can also help treat myasthenia gravis patients who do not have a thymoma.
A recent clinical trial (NCT00294658) showed that thymectomy significantly improves the symptoms of myasthenia gravis patients who were on prednisone treatment but did not have a thymoma. Patients younger than 60 years old who show moderate or severe symptoms of myasthenia gravis can be recommended for a thymectomy. Some patients with mild symptoms can also be candidates for the surgery if they have respiratory difficulties or swallowing problems.
How thymectomy is performed
Surgeons can choose from one of three techniques to perform a thymectomy: transsternal, transcervical, or videoscopic. Patients should be well-informed by their doctors about the advantages and disadvantages of the particular procedure they will undergo.
Each technique applies different methods for thymus removal, and it is currently not established which one is best. Some specialists argue it is best to remove the surrounding fat tissue along with the thymus, since this tissue may contain cells from the thymus; others believe it is not necessary.
What to expect before and after a thymectomy
After the operation, a patient may wake up with a breathing tube. Depending on the patient’s condition, he or she may be connected to a ventilator for a short period. Recovery is not painful, and patients are usually discharged within a few days after surgery. Although it varies from person to person, patients are generally expected to be able to return to normal daily activities in three to six weeks.
Thymectomy is a long-term treatment strategy; it does not have acute effects on the symptoms of myasthenia gravis. Although doctors may slightly adjust medications, patients will need to continue their regular treatment. A significant improvement in symptoms due to thymectomy can be expected within one year after surgery. It is possible symptoms will disappear permanently.
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