European Journal of Molecular & Clinical Medicine

Abstract

Background: Myasthenia gravis is a rare autoimmune disease caused by antibodies that probably originate from the thymus glands. In recent years, thymectomy has become a widespread procedure in the treatment of myasthenia gravis (MG). Transsternal approach with thymectomy is the accepted standard surgical approach for many years.
Aim: To evaluate the outcomes of 60 patients who underwent thymectomy for myasthenia gravis, quantify the degree of clinical improvement after thymectomy by evaluating changes in stage and medication requirement, and identify prognostic factors that may be helpful in determining the best patient selection.
Materials and Methods: The study group consists of 60 myasthenic gravis patients who were admitted to Gandhi Hospital's Cardiothoracic Surgery Department and received a trans-sternal complete thymectomy between February 2014 and December 2022.
Results: 34 (56.7%) were males and 26 (43.3%) were females in the study. Females were aged between 9 to 60 years and mean age was 33.8 years. Before thymectomy, 21 patients were on anticholinestrase agents (Pyridostigmine). Post-operative pathologic study of thymus findings were reported as follows, hyperplasia of thymus was observed in 22 patients (36.6%), thymoma in 13 patients (21.6%), thymic carcinoma, atrophy in 5 patients (8.4%) and normal thymus in 20 patients (33.4%). 16 days was the mean hospital stay with 4 patients having prolonged hospital stay due to complications. Follow up ranged from 7 months to 10 years. Mean follow up is 2.5 years. Complete remission was observed in patients in Osserman stage I, IIA and IIB.
Conclusion: Thymectomy is recommended for patients younger than 60 years with non-thymomatous, generalized AChR antibody-associated myasthenia gravis. The early-onset, severe myasthenia gravis, female, thymic hyperplasia, benefit the most. Patients classified as Osserman Class IIA and IIB benefit most from this procedure.