Myasthenia Gravis Treatment & Surgery

Myasthenia Gravis and Thymoma: A Special Association

• A thymoma is a tumor of the thymus gland; most thymomas are benign but can sometimes be invasive or malignant.
• Approximately 30–40% of people with thymoma also have MG.
• Conversely, about 10–15% of MG patients have a thymoma.
• The presence of thymoma typically worsens MG symptoms and often makes the disease more resistant to medication.

How Thymoma Affects Treatment

• Surgical removal of the thymoma (thymectomy) is mandatory—both to treat the tumor and to improve MG symptoms.
• Delaying surgery can lead to local invasion of the tumor and worse outcomes.
• In thymoma-associated MG, surgery is often performed soon after stabilization with medications or short-term therapies like IVIG or plasma exchange.
• Thymectomy in such cases often results in significant improvement in muscle strength and reduces the need for long-term immunosuppressive drugs.

Common Symptoms of Myasthenia Gravis

Recognizing symptoms early allows for timely treatment:

• Eye symptoms: drooping eyelids (ptosis), double vision (diplopia)
• Facial and throat muscle weakness: slurred speech, difficulty chewing or swallowing, nasal tone of voice
• Limb weakness: especially in shoulders, arms, hips, thighs (proximal muscle weakness) leads to difficulty in combing hair, getting up from sitting position on chair
• Fatigue: weakness worsens with activity and improves with rest
• Respiratory weakness: in severe cases, can lead to a myasthenic crisis—a life-threatening emergency

Seek urgent medical care if breathing becomes difficult.

Complications if Untreated

Without adequate treatment, MG can lead to:

• Myasthenic crisis - a life-threatening exacerbation of myasthenia gravis characterized by severe muscle weakness, particularly in the muscles that control breathing.This weakness can lead to respiratory failure and requires immediate emergency medical care with mechanical ventilation to support breathing.
• Severe malnutrition due to swallowing problems
• Increased risk of infections and pneumonia
• Persistent disability and poor quality of life

Diagnosis of Myasthenia Gravis

A thorough evaluation includes:

• Blood tests: to detect AChR, MuSK, or LRP4 antibodies
• Repetitive Nerve Stimulation Test (RNST): to measure electrical transmission from nerves to muscles
• Chest CT or MRI scans: to detect an enlarged thymus or thymoma
• Pulmonary function tests: to assess breathing muscle strength

Early and accurate diagnosis improves outcomes and helps guide whether surgery is necessary.

Treatment Options for MG

Treatment is individualized and may include one or more of the following:

Medications

• Acetylcholinesterase inhibitors (e.g., pyridostigmine) to improve nerve-muscle communication
• Corticosteroids and other immunosuppressants like Azathioprine or Mycophenolate to reduce antibody production

Advanced Therapies

• IV Immunoglobulin (IVIG) or Plasma Exchange (PLEX) for rapid improvement during flare-ups or before surgery
• Newer biologics like eculizumab or ravulizumab for resistant cases

Role of the Thymus in Treatment

Research—including the landmark MGTX trial (NEJM, 2016)—demonstrates that removing the thymus benefits many patients with AChR-positive generalized MG, even without a thymoma.

Thymectomy:

• Reduces antibody production
• Improves muscle strength and overall disease control
• Decreases long-term reliance on high-dose steroids or immunosuppressants

Who Should Consider Thymectomy?

You may benefit from thymectomy if:

• You have MG with a thymoma – surgery is essential
• You have generalized MG with AChR antibodies, especially if diagnosed before age 60
• Your neurologist recommends surgery as part of your treatment plan

Earlier surgery can improve long-term results.

Types of Thymectomy

Open Thymectomy

• Traditional approach via a breastbone (sternum) incision
• Effective but more invasive, more painful and has longer recovery times (6 weeks or more)

VATS (Video-Assisted Thoracoscopic Surgery)

• Minimally invasive using a camera and small incisions. In VATS or Thoracoscopic Thymectomy, sugeons makes small cuts and inserts small tubes called ports into the side of chest. A camera is then inserted through the central port and two lung instruments are inserted fro the rest of the two ports and the thymus gland along with surrounding fat is removed surgically with the surgeon looking at a video from the camera on the screen in front.
• Faster recovery and less pain than open surgery

Robotic Thymectomy (Preferred)

• The latest advancement offering greater precision and superior visualization
• Particularly beneficial in thymoma-associated MG and complex mediastinal anatomy
• Benefits include:
• Smaller incisions and better cosmetic results
• Less pain and shorter hospital stay
• More complete removal of thymic tissue, crucial for optimal results in MG
• Faster return to normal activities

At our center, we specialize in robotic subxiphoid thymectomy, which offers excellent access to the thymus with minimal chest wall trauma and less pain.

Recovery After Thymectomy

• Hospital stay is typically 2–4 days
• Gradual improvement in symptoms occurs over weeks to months
• Medication doses are often reduced after surgery under neurologist guidance
• Regular follow-up ensures continued progress and safety

Long-Term Outcomes

• Many patients experience significant improvement or remission.
• Need for immunosuppressive medication often decreases
• Robotic surgery provides outstanding safety and success rates

Our Center’s Unique Strengths

• Led by Dr. Belal Bin Asaf – among India’s most experienced robotic thoracic surgeons, renowned for expertise in thymectomy for MG and thymoma
• Pioneering experience in robotic subxiphoid thymectomy for safer, less invasive surgery
• Multidisciplinary team of neurologists, anesthetists, ICU staff, and rehabilitation specialists
• Proven track record of excellent patient outcomes and international-standard care

Reassurance for Patients and Families

We understand that a diagnosis of MG, especially with a thymoma, can be frightening.

You can trust that:

• Robotic thymectomy is safe and effective, even for complex thymomas
• Our team prioritizes patient comfort, safety, and individualized care
• Early intervention often results in marked improvement and a better quality of life

Book a Consultation with Dr. Belal Bin Asaf