Thymectomy in the treatment of myasthenia.

Thymectomy has been performed in 69 patients, 58 females and 11 males, age range 14 to 70 years, with a maximum in females between 20 to 30 years. Twenty-seven percent of the patients were older than 40 years. Considerable improvement resulting from remission and partial remission occurred in 89% of females and in about 50% of males, the figure for thymomatous myasthenia was about 65% in the first year after thymectomy. In the following years, improvements increased partially and the number of remissions rose as well. By chance the duration of the disease was longer than 6 years in 20% of our patients and in these a benefit from thymectomy was also found. There were 7 early deaths and 4 late deaths. Thymectomy cannot be called a cure but is an essential part of the whole treatment procedure of myasthenia comprising the administration of anticholinesterase and especially immunosuppressive agents. It was found difficult to estimate the effect of any single measure in this retrospective study by the major benefit of thymectomy is seen in initiating remissions or at least considerable improvements. Indication for operation is thought to be present in progressive myasthenia, acute or chronic, and thymoma, provided that the patient has reached an optimal condition preoperatively by adequate anticholinesterase adjustment, neurophysiological control and immunosuppressive treatment. Thymectomy is not an emergency operation and should be carefully planned. Since relapses after thymectomy are not rare, a careful neurological long-term follow-up appears obligatory.