Thymectomy
By The Myasthenia Gravis Association of Western PA
One type of treatment for MG is a thymectomy. A thymectomy is a type of surgery that removes the thymus gland, which is located in the upper portion of the chest behind the breastbone or sternum. The thymus gland, especially early in life, is involved in the development of the immune system which enables the body to defend itself against infection.
The thymus produces certain cells called T-cell lymphocytes, which are a vital part of the immune system. These T-cell lymphocytes stimulate the production of antibodies whose job it is to recognize and fight off foreign invaders called antigens. Normally the antibodies destroy the antigens before major illness occurs. However, in MG, the exact role of the thymus is unknown.
In a person with MG, the thymus may be normal or it may have an abnormal increase in the number of cells - called thymic hyperplasia. Or the thymus may contain a tumor called a thymona. This is most like non-cancerous. To determine the status of the thymus, the medical doctor may order specialized x-rays, such as a CT scan of the chest.
Thymectomy is not a new treatment for MG. Since the late 1930s when Dr. John Blalock first removed a thymus gland, thymectomies have been performed around the world as part of the treatment for patients with MG. Not everyone diagnosed with MG will undergo a thymectomy. In most treatment centers, surgery is reserved for adolescents and young adults unless a tumor is suspected. Surgery may then be offered regardless of the patient's age, so long as he or she is a reasonable surgical candidate.
Once the decision to have a thymectomy is reached by the patient and the medical doctor, the patient will be referred to a surgeon. After the surgeon reviews the specialized x-rays and agrees that a thymectomy may be beneficial, a hospital admission will be required. The surgeon will select the best surgical approach.
A thymectomy may be performed in one of two ways. In the transsternal approach, an incision is made over the patient's sternum or breastbone. Once the sternum has been exposed, it is separated in the center so that the thymus gland can be visualized and removed. In the transcervical approach to thymus surgery, a small horizontal incision will be made across the lower portion of the neck. The incision will be just above the breastbone. The surgeon will then remove the thymus gland.
Before the surgery, blood and urine tests may be performed. Muscle strength and breathing ability will be tested so that there will be a base from which to evaluate post-operative progress. The patient will also visit with the anesthesiologist to inform him/her about any allergies and all medications that are currently being taken. Food and fluids will be withheld after midnight or on the day of the surgery and some routine MG medications may or may not be given. On the morning of surgery, a pre-operative medication may be given by injection. This medication can cause relaxation, drowsiness, and dryness of the mouth.
After surgery has been completed, a 1-3 hour stay in the recover room is required. Once the effect of the anesthesia has worn off, the patient will be transported to a room in the hospital. In this phase of recovery, fluids and medication will be given by means of a needle in the vein called an intravenous or IV. As is the case in any surgical procedure, some pain or discomfort may be experienced. The nurse should be notified so that any medication the doctor has ordered for pain relief can be administered. Deep breathing, coughing, and frequent turning while in bed are essential throughout the post-operative period. The nurse will assist with these procedures. Measurements will again be taken of muscle strength and breathing ability. These measurements will be used to determine the amount of myasthenic drugs required after surgery. There may also be an increase in muscle weakness in some patients. However, through close clinical observation by the health care team, treatment will be adjusted to meet individual needs.
Once fluids are tolerated by mouth, the intravenous fluids will be stopped. Solid foods will be started slowly and the patient's medications will once again be given by mouth. The length of the hospital stay varies for each patient.
In the end, thymectomy may lessen the severity of the myasthenic symptoms; however, the degree to which the symptoms are lessened differs in each patient. A slight improvement in muscle strength, or a remission may occur. Remission, which may be either temporary or permanent, is the complete elimination of symptoms without medication.
It is only natural to expect immediate results after surgery. However, the improvement in muscle strength may occur within a period of several months or may take as long as a few years. In most instances, the symptoms of MG can be controlled with a combination of treatments including thymectomy. Together, these treatments can improve the quality of life for the MG patient.
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This is an excerpt from a publication that was written by the Myasthenia Gravis Association of Western Pennsylvania. For more information on this topic or for a free copy of the entire publication, please contact the MGA of WPA office at (412) 566-1545 or via email at mgaoffice@mgawpa.org. Please do not copy or reproduce this article without the written permission is of MGA of WPA.
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