Thymectomy is a type of surgery for myasthenia gravis (MG). It involves removing the thymus gland. Modern thymectomy techniques are minimally invasive and can have long-term benefits for symptoms.
Surgeons may remove the thymus gland to reduce the immune cell effects on myasthenia gravis (MG) symptoms and remove any attached tumors, called thymomas.
The thymus is a gland in the neck. Immature immune T-cells, which are made in the bone marrow, travel to the thymus to become mature, active immune cells. The function of the thymus declines with age, so thymus removal does not have a substantial impact in older adults.
Read on to learn more about what MG surgery involves and when doctors recommend it. This article also looks at the benefits of the procedure, possible risks, preparing for surgery, and more.
Thymectomy is a surgical procedure that can help treat MG. A thymectomy involves removing the thymus gland, which sits at the front of the chest and extends into the neck.
The classical transsternal approach
The Myasthenia Gravis Foundation of America reports research indicates this minimally invasive approach may be as effective as the more invasive sternotomy.
Robotic thymectomy procedures are also available. These may reduce blood loss during surgery, days in hospital, and postoperative complications.
A person’s surgeon can advise on what approach they recommend.
Doctors may recommend thymectomy for people under 60 years old who have moderate to severe symptoms, as these have the best chance of a favorable outcome.
The Muscular Dystrophy Association (MDA) reports that most surgeons avoid performing the procedure on children who have not yet been through puberty, as the thymus plays a key role in immune system development before adulthood.
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Learn about myasthenia gravis and treatment options for the condition.
MG surgery may produce long-term symptom remission without the use of medications, according to the MDA.
Research indicates that thymectomy can lead to symptom remission for at least a year in up to 50% of people who undergo the procedure.
The remaining 50% show improved muscle strength and reduced medication use. Benefits might take several months or years to become clear after surgery.
According to the MDA, before the procedure, a doctor may need to either perform a preoperative plasma exchange or administer intravenous immunoglobulin (IVIg) to help reduce the risk of complications after surgery.
During the plasma exchange, a machine removes blood, separates the liquid plasma, and removes immune proteins such as antibodies.
They then combine blood cells with replacement fluid and return them to the body. This “cleans” the blood, which can help with some autoimmune diseases, such as MG.
Some people might also need therapy to suppress the immune system before a thymectomy.
The medical team will need to advise on any medications someone is taking before this procedure, so it is important to make a doctor aware of any ongoing medications beforehand.
The Myasthenia Gravis Foundation of America reports that most people are typically ready to return home between a few days and 1 week after surgery.
Depending on how severe MG symptoms are and the type of thymectomy, a person may need to use a ventilator for breathing during the procedure and immediately afterward. However, the surgeon removes this and supports the individual in resuming regular breathing to keep the lungs clear of fluid.
Pain is usually minimal or mild after the less invasive procedures, though late pain may occur. It is manageable with pain medication after a transsternal thymectomy, typically resolving within 3 to 5 days.
People who lift heavy loads or spend long periods moving around may require a longer recovery period. Parents caring for young children may need assistance until they can comfortably lift 25 to 30 pounds.
Most people experience few problems after the procedure and can usually return to their regular activities.
However, a
If a surgeon does not completely remove the thymoma, symptoms or tumors
A person’s doctor can provide them with more information about the possible risks of MG surgery.
No full cure is available for MG. However, other treatments a doctor may recommend include:
- pyridostigmine (Mestinon) to improve muscle strength
- eculizumab to block proteins that harm the communication point between nerves and muscles
- immunosuppressive drugs such as prednisone, azathioprine, mycophenolate mofetil, and tacrolimus to suppress production of abnormal antibodies
- plasma exchange and IVIg to remove antibodies, which can be effective for
a few weeks or months - gentle exercise to help improve quality of life
Is a thymectomy a major surgery?
Depending on the approach, a thymectomy may be a major surgery. However, modern surgical methods,
Does myasthenia gravis go away after thymectomy?
The MDA reports that MG symptoms enter long-term remission for around 50% of people who undergo thymectomy. Many others who receive a thymectomy find that they have less muscle weakness and need fewer medications. However, symptoms can take months or even years to get better.
What is the best treatment for myasthenia gravis?
The best treatment for MG depends on a person’s individual needs. Some people will be able to manage the condition with medications. In some cases, a doctor may recommend surgery as the best treatment for MG.
How much does myasthenia gravis surgery cost?
The cost of MG surgery depends on the type of surgery and the number of days necessary for in-hospital recovery.
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Insurers will often cover a thymectomy but may have exclusions around certain healthcare professionals or hospitals. Check with the insurance provider before confirming a procedure.
What happens if your thymus is removed?
Removing the thymus does not substantially affect immune function after the teenage years but may reduce or eliminate the autoimmune cells that cause symptoms of MG.
Myasthenia gravis (MG) surgery involves removing the thymus in a procedure called a thymectomy. A surgeon can remove the thymus using a robot- or video-assisted minimally invasive procedure.
The procedure resolves symptoms in the long term for around half of all people who receive it. Some recovery can take around a week, while a full return to regular activities may take longer.