MEDICAL SECOND OPINION

Thymectomy & Myasthenia Gravis

The thymus is in your rib cage before the trachea (the windpipe). The thymus, an endocrine gland, begins to downsize starting in adolescence. This organ, which plays a very significant role in the maturity of the immune system after birth, weighs about 20 g. The organ continuously enlarges, resulting in two times the weight at birth (approximately 40 g).

The thymus plays significant roles in the body's immunity system up to adolescence. This gland takes a role not only in the production of antibodies but also in cellular defense.
Thymectomy implies the surgical removal of the thymus.

Thymectomy is indicated for the tumor of the thymus (thymoma). Thymoma causes cough due to the gland's proximity to the windpipe and shortness of breath in case of pulmonary metastasis. On the other hand, thymoma is associated with a neuromuscular disease, namely Myasthenia Gravis, in one-third of cases with thymoma.
Myasthenia Gravis is principally a neurological disorder, and the underlying cause is an abnormality of the immune system. Although the condition is common in young women and older men, it can be seen at all ages. Our muscles are signaled by the nervous system to contract or relax. When the immune system functions abnormally, antibodies attack the junction of nerves and muscles.

The receptor implies the structure of the muscle and senses the signals transmitted by nerves. Chemical substances play a role in this transmission between muscles and nerves. Acetylcholine is a chemical substance that is commonly cited in Myasthenia Gravis. The ultimate result is the body's attack on its own tissues, referred to as an autoimmune disorder in medical terminology. This disorder causes the inability of muscles to receive contraction and relaxation muscles carried by nerves. In conclusion, various symptoms emerge depending on the muscle involved, including but not limited to droopy eyelids, double vision, and weakness of arm(s) and leg(s). If muscles of the neck and throat are involved, it may cause an inability to keep the head upright, difficulty swallowing, and changes in the voice tone.

However, Myasthenia Gravis can occur without antibodies that compromise the communication between muscles and nerves. Therefore, there is no consensus on the factor that causes the autoimmune reaction – the underlying factor of Myasthenia Gravis. Thymectomy is the absolute indication of the concomitant presence of Myasthenia Gravis and thymoma. However, thymectomy may help relieve symptoms of thymectomy if symptoms of thymoma are absent.

Diagnosis:

The first step of diagnosis in Myasthenia Gravis involves a review of all symptoms and the health history. A physical examination is made that reviews all systems. Myasthenia Gravis is a neuro-muscular disease, so the physical examination focuses on the nervous system and muscles. Vision, coordination of movements, reflexes, muscle strength, tone, tactile sensation, and postural balance are assessed in detail.

Blood analyses are required to investigate autoantibodies that cause Myasthenia Gravis. Your doctor can order electromyography (EMG) to determine how much your muscles are involved.

Pulmonary function tests are ordered to check the findings of your respiratory system.
CT or MRI is scanned to rule out or reveal the association between Myasthenia Gravis and thymoma.

Treatment:

Treatment of Myasthenia Gravis starts with an accurate diagnosis.
The principal problem is that the thymus produces auto-antibodies that attack the native cells of the body, resulting in compromised neural conduction at the neuromuscular junction.

Therefore, medical treatment includes medications that improve neural conduction or suppress the immune system (corticosteroids and other immunosuppressive agents).

Another non-surgical treatment option is plasmapheresis. Plasmapheresis removes auto-antibodies that damage the receptors, which regulate the transmission of relaxation or contraction signals from the blood to the muscles. A particular machine filters your blood in this procedure. This treatment option enables regression of complaints for several weeks, as auto-antibody production will continue.

The last non-surgical option is intravenous immunoglobulins. Antibodies with normal function are administered into blood vessels to treat the condition. Although the risk of side effects is lower than immunosuppression and plasmapheresis, therapeutic effects are temporary and short-lasting, as is the case for the other two options.

Surgical removal of the thymus:

Thymectomy is the absolute indication of the simultaneous presence of Myasthenia Gravis and thymoma. However, thymectomy may help relieve symptoms of thymectomy if symptoms of thymoma are absent. The thymus gland can be removed with open surgery, minimally invasive surgery, or videothoracoscopic technique.
pain, and shorter stay at hospitals. Still, the thoracic surgeon will determine the best option.

Supportive treatment and lifestyle changes. Your doctor may recommend medications to manage muscle weakness and fatigue.
Particular symptoms, such as weakness of muscles and double vision, will bring safety risks in your social and work life, such as falls and fall-related injuries. Therefore, those risks can be minimized by assembling handles and handrails to corridors, stairs, and bathrooms. It would help you efficiently use your muscle strength and energy in Myasthenia Gravis. You may even need help for activities of daily living when symptoms exacerbate.

There is some evidence that stress aggravates symptoms of Myasthenia Gravis. Therefore, stress management is a factor that should not be ignored in managing this condition.

Created at 11.10.2023 03:43
Updated at 27.05.2024 12:59

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