A thymectomy is recommended for patients under the age of 60 years who have moderate to severe weakness from myasthenia gravis. It may be recommended for patients with mild weakness if it impacts breathing or swallowing. The procedure is also recommended for anyone with a thymoma.
Which type of thymectomy should I have?
The transsternal thymectomy is the most commonly performed procedure, however there are no proven differences in outcomes with less invasive approaches. Your neurologist and surgeon will guide you in making a decision about the type of thymectomy you should have.
When is thymectomy indicated for myasthenia gravis (MG)?
Thymectomy is always an elective procedure and should be performed when the patient is stable and deemed safe to undergo the procedure. Thymectomy is generally not recommended for ocular MG, but may be an option if drug therapy is inadequate ( Liu et al., 2011; Mineo et al., 2013; Roberts et al., 2001; Sanders et al., 2016; Schumm et al., 1985 ).
What is the gold standard approach for thymectomy?
The gold standard approach for thymectomy is a median sternotomy or transsternal approach, but this has evolved to less invasive techniques such as upper partial sternotomy, transcervical, video-assisted thoracoscopic thymectomy, and robot-assisted approaches.
What is a transcervical thymectomy?
Transcervical thymectomy: In this procedure the incision is made across the lower part of the neck, just above the breastbone (sternum). The surgeon removes the thymus through this incision without dividing the sternum. This is mostly used in patients without thymoma with certain body-types.
What conditions do doctors prescribe thymectomy?
Thymectomy is recommended for all patients with thymomas and for patients under 60 who have mild to moderate muscle weakness due to myasthenia gravis. Thymectomy generally is not used for treating patients with myasthenia gravis that affects only their eyes.
When is thymectomy indicated?
Thymectomy is recommended for patients younger than 60 years with non-thymomatous, generalized AChR antibody-associated MG. The role of thymectomy in ocular MG is controversial. Plasmapheresis or intravenous immunoglobulin is recommended before thymectomy in patients with preoperative respiratory or bulbar symptoms.
What is a thymectomy and why is it performed?
Thymectomy is the surgical removal of the thymus gland, which is located just under the breast bone. It is an effective treatment for people who have myasthenia gravis, a neuromuscular disorder, or thymoma, a tumor of the thymus gland.
Does a thymectomy cure myasthenia gravis?
Thymectomy, the surgical removal of the thymus gland (which often is abnormal in individuals with myasthenia gravis), reduces symptoms in some individuals without thymoma and may cure some people, possibly by re-balancing the immune system. Thymectomy is recommended for individuals with thymoma.
What causes myasthenia gravis?
Cause of myasthenia gravis Myasthenia gravis is caused by a problem with the signals sent between the nerves and the muscles. It's an autoimmune condition, which means it's the result of the immune system (the body's natural defence against infection) mistakenly attacking a healthy part of the body.
What is thymoma in myasthenia gravis?
Thymomas in myasthenia gravis (MG) are neoplasms derived from thymic epithelial cells, and are usually of the cortical subtype (WHO type B) [1]. 50% of thymoma patients develop MG (hereafter referred to as thymoma MG in this paper) [2, 3].
Who needs a thymectomy?
A thymectomy is recommended for patients under the age of 60 years who have moderate to severe weakness from myasthenia gravis. It may be recommended for patients with mild weakness if it impacts breathing or swallowing. The procedure is also recommended for anyone with a thymoma.
What happens during thymectomy?
Transcervical thymectomy: In this procedure the incision is made across the lower part of the neck, just above the breastbone (sternum). The doctor removes the thymus through this incision without dividing the sternum.
What is the best treatment for myasthenia gravis?
What Are the Treatments for Myasthenia Gravis? There is no cure for myasthenia gravis, but it is treated with medications and sometimes surgery. You may be put on a drug called pyridostigmine (Mestinon), that increases the amount of acetylcholine available to stimulate the receptors.
What is myasthenia gravis surgery?
Key Info. Myasthenia Gravis is a chronic autoimmune condition. Treatment involves surgical removal of the thymus, which can be done in a number of ways. Non-surgical options such as plasmapheresis, immunoglobulin, and medications can help treat symptoms of myasthenia gravis but cannot cure the condition.
How is thymus gland related to myasthenia gravis?
Researchers believe that the thymus gland triggers or maintains the production of the antibodies that block acetylcholine. Large in infancy, the thymus gland is small in healthy adults. In some adults with myasthenia gravis, however, the thymus gland is abnormally large.
Why does thymoma cause myasthenia gravis?
Myasthenia gravis is a disorder with fluctuating weakness of skeletal muscle that is caused by autoantibodies to nicotinic acetylcholine receptors (AChR) at the neuromuscular junction. An inflammatory myopathy of striated and cardiac muscle develops in some patients with thymoma-associated MG.
How to perform a thymectomy in rats?
Thymectomy is performed in young (6-week old) rats by splitting the upper third of the sternum via a midline cervicothoracic incision. The thymus is exposed, grasped gently, teased away from the surrounding tissues, and removed intact. The strap muscles and sternum are reapproximated rapidly using a single 4-0 silk suture. The chest should be compressed transiently to remove residual air as the sternal incision is closed. After sacrifice, the animals should be examined for remnants of thymic tissue, and if part of an experiment involving complete thymectomy, those with retained tissue must be excluded. If pure thymocytes are being collected, it is important to remove the parathymic lymph nodes embedded on either side of the gland because they may contaminate the desired cell population. The thymus of mice can be aspirated via a small neck incision.
Does thymectomy increase mortality?
Thymectomy increases the mortality of REV-T-infected birds suggesting the involvement of cell-mediated immunity in the elimination of RE virus-infected cells. Cytotoxic T lymphocytes (CTL) lyse virus-infected cells which present viral antigens in conjunction with the major histocompatibility complex (MHC) class I molecules. CTL are induced 7 days after infection with RE viruses and may persist at least 21 days. The CTL response against RE viruses is mediated by γδ T CD8+, CD4− cells which express MHC class I and II molecules. RE viruses do not appear to activate natural killer cells.
Is thymectomy effective for MG?
Thymectomy is regarded as an effective treatment in early onset MG with AChR antibodies (Gilhus and Verschuuren, 2015 ). In addition, many patients with late onset MG with AChR antibodies in the age group 50–65 years seem to have an effect. MG patients with MuSK antibodies do not have any benefit of thymectomy, and thymus is not involved in this disease. For generalized MG without detectable antibodies, thymectomy is not recommended. However, patients in whom AChR antibodies are present but undetectable in routine testing, thymectomy would be expected to be of benefit. Patients with a thymoma should have thymectomy to remove the tumor. In some thymoma MG patients, the MG symptoms improve after removal, but the clinical development after thymectomy is more variable than without a thymic tumor. For ocular MG, thymectomy is debated. There are some data indicating that early thymectomy reduces the risk of generalization and improves the strength of the ocular muscles. Benefit of thymectomy does not seem to correlate with AChR antibody concentration. Titin antibodies in MG patients without a thymoma may indicate less benefit from thymectomy, but prospective studies are lacking. Nor is there evidence that imaging markers (MR, CT) of thymus can be used to predict the response to thymectomy.
Is thymectomy a treatment for autoimmune disease?
However, this intervention is not associated with resolution of the underlying immunodeficiencies and, other than in the case of associated MG and PRCA, is not associated with improvement of clinical autoimmune manifestations. There have been scattered case reports of radiation therapy, but no convincing evidence that this impacts on the associated immunologically mediated afflictions. Replacement immunoglobulin, most commonly in the form of intravenous immunoglobulin (IVIG), is the standard of care in this disorder, just as it is in the primary immunodeficiency disorders. Indeed, data from retrospective studies strongly suggest that this approach leads to a reduction of bacterial infections.2,4 Given the presence of underlying T cell defects in many of these patients, along with the presence of anemia, blood transfusions should be undertaken with irradiated blood to preclude the development of graft-versus-host disease. In addition, patients who lack CMV antibodies should receive blood from serologically-negative CMV donors when this therapeutic modality is indicated. Moreover, given their underlying immunological liabilities, patients should receive vaccines derived from attenuated or killed organisms. Box 48.1 summarizes the characteristics and treatment of Good syndrome, and a comparison of disease characteristics of this immune deficiency disorder and those described in the following sections appears in Table 48.2.
Does thymectomy abolish antibody synthesis?
Thymectomy in Xenopus either decreases or abolishes allograft rejection, MLR, PHA responsiveness, IgY antibody synthesis and antibody responses to thymus-dependent antigens. It does not abolish in vivo or in vitro responses to thymus-independent antigens or B cell polyclonal activation (LPS). In vitro assays using purified T and B cells from carrier- or hapten-primed Xenopus of various MHC types indicate that T cell help is involved in the differentiation of thymus-dependent antigen-primed B cells and that T–B collaboration is MHC restricted. IgM is produced first following antigenic stimulation, and then is produced in conjunction with IgY. A second injection generates a significantly stronger (×10–100), mainly IgY, secondary response. Although somatic mutation occurs in Xenopus V H segments at almost the same frequency found in mammals, these mutations may not be properly selected, perhaps because of the absence of germinal centers in the lymphoid organs.