For some people with myasthenia gravis (MG), thymectomy can make a big difference. By removing the thymus gland, this surgery helps reduce muscle weakness and fatigue. About 70 percent of those who undergo thymectomy see improvement, and 30 percent to 40 percent go into full remission. Results vary, so talking with your doctor can help you decide if this treatment is right for you.

MG can worsen over time, so finding a treatment that controls or eliminates your symptoms can be a major win for your long-term quality of life. Treating MG early may help prevent complications and reduce the need for stronger medications down the line. While thymectomy isn’t right for everyone, it offers a chance for lasting symptom relief in some people.

How Thymectomy Works

Thymectomy removes the thymus gland, which plays a significant role in causing MG symptoms. Your thymus gland is in your chest area and is part of your immune system. The gland makes antibodies, which are proteins that help the immune system. In MG, these antibodies can block signals between nerves and muscles, causing weakness.

People with MG have overactive or enlarged thymus glands, which produce too many of these harmful antibodies. When the antibodies block signals between nerves and muscles, you experience the classic muscle weakness and pain associated with MG. Some people with MG have thymus tumors, called thymomas, which can also cause an overactive thymus.

Removing the thymus gland with thymectomy can help calm down your overactive immune system because MG is an autoimmune disease. In autoimmune diseases, the immune system mistakenly attacks healthy parts of the body — in MG, it disrupts communication between nerves and muscles. Removing the thymus gland can help reduce this immune system attack, leading to fewer MG symptoms and less need for other treatments.

Thymectomy Techniques

Surgeons use different approaches to perform thymectomy. The transsternal method was once the most common surgical technique. It involves a large incision down the breastbone to reach the thymus gland, similar to open heart surgery.

Today, surgeons are using minimally invasive thymectomy techniques more often. These techniques use smaller incisions with video or robotic assistance. Minimally invasive approaches involve shorter hospital stays and quicker recovery, and they have lower complication rates than more invasive techniques.

What To Expect From Thymectomy

You can expect your thymectomy to take between two and four hours, depending on the technique your surgeon uses. In most cases, thymectomy is an inpatient surgery, which means you stay in the hospital for at least one night. During this time, your medical team will monitor your recovery, manage any pain, and ensure there are no complications before you go home.

Your surgeon gives you details about your procedure and what to expect during your thymectomy based on the technique, such as how long it should take and the recovery timeline. An anesthesiologist administers general anesthesia and closely monitors you during the surgery. General anesthesia puts you to sleep, so you won’t remember the operation.

Preparing for Thymectomy

Before surgery, your healthcare provider will review your medical history, perform a physical exam, and give you instructions to prepare. They may also order tests to make sure you're a good candidate for thymectomy. These tests can include:

• Cardiac stress test
• Electrocardiogram (EKG)
• Pulmonary function test
• Imaging scans (CT, MRI, or positron emission tomography)

As the date of your surgery gets closer, your healthcare provider might advise you to stop taking specific medications or supplements. Typically, you’ll continue taking your MG medications unless your surgeon or anesthesiologist tells you otherwise. They’ll also advise you not to eat or drink anything after midnight before your thymectomy.

In some cases, your doctor may recommend plasma exchange or intravenous immunoglobulin (IVIG) before surgery to help strengthen your muscles and lower the risk of complications, including breathing problems during the procedure. IVIG is a treatment that delivers antibodies into your bloodstream to help regulate the immune system.

Recovering After Thymectomy

Hospital stays after thymectomy vary, but you can expect plenty of support while you’re there, including pain medication, oxygen, and IV fluids. You’ll be encouraged to move around as soon as possible to help in your recovery.

Fortunately, the pain is manageable. Contact your provider right away if you experience worsening MG symptoms, chest pain, fever, or bleeding from your incision(s) as you recover from your thymectomy.

The Benefits of Thymectomy

Some people go into remission after the surgery. If you’re in MG remission, you no longer experience weakness and don’t need any further treatment for MG. It is important to understand that the benefits of thymectomy may not be immediate. It can take several months, or even up to a year, to see the full effects. As one MGteam member shared, “It took a few years, but the thymectomy seems to have kicked in. My eyes are the last thing affected and luckily, I only get double vision occasionally.” Regular follow-up appointments with your neurologist are crucial for monitoring your progress and adjusting your treatment plan as needed.

The benefits of thymectomy for MG go beyond getting rid of symptoms. After MG treatment with thymectomy, many people require fewer hospital stays than before they got the surgery.

A 2016 study in the New England Journal of Medicine looked at hospitalization rates in people with MG. Researchers compared those who had a thymectomy and took prednisone with those who only took prednisone to manage MG. This was a randomized trial, meaning people were randomly assigned to different treatment groups to make the results more reliable.

The results showed that the hospitalization rates were significantly lower among the thymectomy group, with just 9 percent of participants being hospitalized compared to 37 percent in the non-thymectomy group in three years.

Prednisone and other steroids commonly treat MG and can reduce symptoms. However, using steroids for a long time can lead to medical complications that impact your quality of life. Long-term use of prednisone and other corticosteroids can cause side effects and complications such as:

• High blood sugar, which can contribute to or worsen diabetes
• Eye problems like cataracts and glaucoma
• Frequent viral, bacterial, and fungal infections
• Osteoporosis (weakening bones)
• Fatigue
• Increased muscle weakness
• Slow wound healing

By getting a thymectomy, you can minimize your use of steroids to reduce your risk for complications like these.

Potential Risks of Thymectomy

While thymectomy offers benefits for many people with MG, the surgery isn’t without risks. Some possibilities include heart injuries, nerve damage, blood loss, and collapsed lung.

The surgery rarely leads to a myasthenic crisis. Myasthenic crisis is a life-threatening complication that happens when the muscles that support breathing become too weak to function. Myasthenic crises can also happen because drugs used in the delivery of general anesthesia can disrupt communication between nerves and muscles.

Scarring After Thymectomy

You can expect to have surgical scars after your thymectomy incisions heal. Scars from minimally invasive thymectomy are small and not very noticeable — only about half an inch long and on the side of your chest.

Who Should Consider Thymectomy?

Ask your neurologist about your best MG treatment options to find out if you’re a good candidate for thymectomy. Generally, doctors consider your age, gender, the severity of your MG symptoms, and whether you have thymic tumors. The decision about whether to proceed with thymectomy is a shared one between you and your healthcare team. Your neurologist will carefully consider all relevant factors and discuss the potential benefits and risks with you to help you make an informed choice.

Elderly people with MG typically have weaker responses to thymectomy, so surgeons may not recommend thymectomy if you’re over age 60. Still, they make decisions on a case-by-case basis, and your age might not disqualify you.

If you're pregnant, you should wait to get a thymectomy until after delivery because of the surgical risks.

What MGteam Members Have Said

Members of MGteam discuss their experiences with thymectomy for MG:

• “I had a thymectomy performed. My double vision was gone immediately. I had absolutely zero pain in my chest after surgery. I would highly recommend it.”
• “I had my thymectomy surgery in 2016 and, although I did not go into remission, the respiratory failure threat was no longer a constant issue.”
• “Doctors determined due to my youth that it was best to remove my thymus to improve my condition. I think it worked.”
• “I’m still recovering from my thymectomy. Two weeks out from surgery and symptoms have improved greatly.”

Talk to Your Doctor

If you have MG, thymectomy may help reduce your symptoms and decrease your need for medication. The surgery isn’t right for everyone, and the benefits take time to appear. Your doctor can help you decide if thymectomy is a good option based on your age, overall health, and how severe your MG is. They can also explain what to expect before, during, and after the procedure. If you’re thinking about thymectomy, talk to your doctor about the risks and benefits to help you make the best decision for your health.

Find Your Team

MGteam is the social network for people with myasthenia gravis and their loved ones. On MGteam, more than 2,800 members come together to ask questions, give advice, and share their stories with others who understand life with myasthenia gravis.

Have you had a thymectomy for myasthenia gravis? Did you benefit from the surgery? Share your experience in the comments below, or start a conversation by posting on your Activities page.