Myasthenia gravis may be associated with various abnormalities of the thymus gland. The thymus gland lies behind the breastbone and is an important part of the immune system in infancy and early childhood. The relationship between the thymus gland and myasthenia gravis has led to the medical recommendation that the gland be removed (thymectomy). About 10 percent
of myasthenia gravis patients have a tumor of the gland (thymoma) and are treated with surgical removal, or thymectomy, as well. Since the 1940's, myasthenia gravis has been treated by thymectomy with most patients showing some improvement after 6 months to 1 year following surgery.
The degree of improvement after surgery is not predictable, but can be significant. Myasthenia gravis patients who experience more than minimal symptoms should consider thymectomy for treatment. University of Maryland thoracic surgeons offer four different surgical approaches for thymectomy, including some which are minimally invasive, to best meet our patients' needs.
Click on any of the links below to learn more about these surgical approaches, what to expect after surgery and more.
The history of thymectomy dates back to 1901 when a thymoma in a patient with myasthenia gravis was described and the association between the thymus gland and myasthenia gravis was first suggested. In 1913, Schumaker and Roth described the fist thymectomy performed 2 years earlier, in 1911, by Sauerbruch.
The exact mechanism by which thymectomy improves the symptoms of myasthenia gravis is not completely understood. Nevertheless, myasthenia gravis patients who undergo thymectomy do experience fewer exacerbations ("flare-ups"), have milder symptoms, require lower medication doses and have a higher chance of complete remission.
Various types of thymectomy procedures are performed at the University of Maryland Medical Center. The Medical Center has recently installed state-of-the-art operating rooms outfitted with the newest videoscopic equipment, earning the title: "OR of the Future."
Our surgeons are experienced in all of the surgical approaches to thymectomy and have performed thymectomy on hundreds of patients safely and successfully.
Thymectomy can be performed using several surgical approaches. Your surgeon will determine the optimal surgical procedure for you, based upon your general health status, physical build and the absence of a thymoma.
While our thoracic surgeons are very familiar with the management of myasthenia gravis, the myasthenia gravis patient will benefit from expert management by Center medical director Charlene Hafer-Macko, a neurologist who has special expertise in caring for patients with myasthenia gravis.
If necessary, available treatments include intravenous immune globulin (IVIG) and plasmapheresis, which can be utilized both before and after the surgery as determined by the neurologist. The neurologist who will be caring for the patient during the hospital stay will communicate with the patient's community neurologist and will keep them informed of their progress during the hospital stay so that they will be prepared to take care of the patient again once they have recovered from thymectomy.
The number of days in the hospital will vary with each patient, surgeon and surgical approach. In most cases, the patient is ready for discharge from the hospital in 1-3 days. Discharge from the hospital may be delayed in the event of a "flare-up" of myasthenia symptoms.
Regardless of the approach used, the surgeon will remove the entire thymus gland and send it for analysis. The pathologist will inspect the tissue for thymoma and other abnormal cells. The final pathology report is usually ready in 10-14 days. The surgeon will notify the patient of the results at the surgical follow-up appointment, usually 2-4 weeks after discharge.
The recovery period or time away from work or school varies with the specific surgical approach used and the type of work or activity the patient does regularly. Recuperation from a full sternotomy approach may require up to 3 months off from work. This time period is significantly shorter with less invasive surgical approaches and may be as little as 1-2 weeks with the transcervical thymectomy approach.
It is especially important that patients ensure that their myasthenia gravis symptoms are well controlled in the postoperative period while they are recovering from surgery. The neurologist will be very involved in adjusting the medication dosages for optimum control of symptoms.
Most patients will notice improvement in their myasthenia gravis symptoms after surgery but may still have flare-ups occasionally, although these flare-ups are likely to be milder than they would be without thymectomy. It may take up to 6 to 12 months for patients to notice significant improvement in their symptoms.
The timing of returning to work or school and resuming driving privileges will be decided by both the neurologist and the surgeon. This usually occurs once the patient is well healed from the surgery and their myasthenia gravis is under control.