Role of thymectomy in Myasthenia Grevis
What is the role of thymectomy in the treatment of Myasthenia Grevis?
Although prospective, randomized, controlled trials have not been performed, the beneficial effects of thymectomy in patients with Myasthenia Grevis (with or without thymic tumor) have been demonstrated in a plethora of studies.
Over 75% of patients experience some benefit, which may include a reduced requirement for immunomodulatory therapy, a greater likelihood of successful taper of immunosuppressant medication with continued control, and a greater chance of permanent symptomatic remission.
The extended transsternal approach (sternal split with removal of the thymus and visual exploration of the mediastinum for removal of ectopic thymic tissue) appears to confer the best balance between benefit and risk, and is extremely safe in experienced hands.
Benefits in children and patients over 60 years of age are less clear, and these groups may be at greater risk for the procedure.
The congenital myasthenic syndromes do not appear to be immune-mediated and do not respond to thymectomy.
