Evaluation for thymectomy in adult patients with myasthenia gravis

Thymectomy is indicated as an adjunct to pharmacotherapy for selected patients with MG to reduce symptoms and the long-term exposure to medications and to improve outcomes. The optimal timing for thymectomy in those without thymoma is not established. All patients having thymectomy should have a preoperative anesthesia consultation.

MG: myasthenia gravis; CT: computed tomography; MRI: magnetic resonance imaging; AChR: acetylcholine receptor; MuSK: muscle-specific tyrosine kinase; LRP4: low-density lipoprotein 4.

* Refer to UpToDate topics that review symptomatic treatments (anticholinesterase inhibitors), chronic immunotherapies (glucocorticoids and other immunosuppressive drugs), and rapid immunotherapies (plasma exchange and intravenous immune globulin) for MG.

¶ Patients with MuSK antibody-positive MG do not typically require mediastinal imaging because thymic abnormalities and thymomas are not associated with MuSK antibodies.

Δ Preoperative biopsy is necessary if the anterior mediastinal lesion is not well circumscribed (signs of local infiltration) or if the patient has systemic symptoms that suggest another diagnosis.

◊ For patients with significant preoperative respiratory or bulbar symptoms, treatment with plasmapheresis or intravenous immune globulin is warranted prior to surgery.

§ Symptoms include persistent diplopia in primary gaze or severe bilateral ptosis as well as intolerable adverse effects from pharmacotherapy.

Graphic 109723 Version 4.0

خرید پکیج

Evaluation for thymectomy in adult patients with myasthenia gravis