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Benefits of Thymectomy in Treating Myasthenia Gravis – Neurology opinion editorial

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Myasthenia Gravis

In 2016, a groundbreaking study led by Gil I. Wolfe, a distinguished professor at SUNY and an expert in neurology, examined the effects of removing the thymus gland on patients with myasthenia gravis.

The results unequivocally supported the advantages of thymectomy, showing its lasting benefits for up to five years in MG patients without chest tumors.

A follow-up study conducted by Wolfe and published in The Lancet Neurology in 2019 reaffirmed these positive outcomes.

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Last year, a publication in the New England Journal of Medicine sparked controversy within the medical and surgical fields by questioning the practice of thymic removal.

According to Wolfe, the paper suggested that removing the thymus could potentially double the risk of cancer and mortality over the next ten to twenty years, as well as raise the likelihood of developing autoimmune disorders.

This led to a flurry of responses from clinicians expressing worries about the implications raised by the paper. Wolfe notes that while thymus removal is typically necessary in cases involving tumors like thymoma, there has always been some level of concern surrounding this procedure.

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No signal of concern

Investigators have been searching for any negative effects of thymus gland removal for years without finding any cause for concern.

A recent study has brought up this issue again, prompting us in the myasthenia gravis treatment community to discuss the long history of thymectomy safety in the disease.

We want to address all aspects of this topic and highlight important questions raised by the latest study that were not adequately addressed in the paper or accompanying editorial.

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In April, Wolfe co-authored an opinion piece in Neurology titled Does Surgical Removal of the Thymus Have Harmful Effects? in response to the NEJM study.

According to Wolfe, thymectomy is primarily performed for therapeutic reasons, such as when a tumor necessitates removal or as a treatment for MG.

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However, he notes that during cardiac surgery, partial removal of the thymus is commonly done to ensure a clear surgical field.

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Many believe that thymus function becomes less important with age and is often considered dispensable like the appendix.

The article explains that the thymus gland plays a vital role in training T cells early in life to recognize foreign invaders like bacteria and viruses.

Normally, the thymus eliminates T cells that target self-antigens, which are tissues of one’s own body, but in certain immune-mediated diseases like myasthenia gravis, this process malfunctions leading to autoimmunity.

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Improved outcomes

He elaborates on the effectiveness of thymectomy in the most common form of MG, without an underlying thymoma.

Thymectomy has been shown to enhance outcomes using both objective and subjective measures, decrease the need for medications such as corticosteroids, and lower the frequency of hospitalizations and emergency treatments for the disease.

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Wolfe states that there was a significant statistical difference in all these outcomes compared to patients solely treated with medication.

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This approach is not novel, having been utilized for over 80 years; however, it was only recently proven effective through a well-designed clinical trial.

The conviction in its efficacy had been held by many professionals in the field for decades. A team of nearly 300 investigators and research personnel worldwide successfully demonstrated this belief.

He acknowledges the support from various organizations such as the National Institute of Neurological Disease and Stroke, the Muscular Dystrophy Association, and the Myasthenia Gravis Foundation of America for enabling research on myasthenia gravis.

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Alongside co-authors like Yaron Perry from UB, colleagues from institutions like George Washington University, the University of Alabama at Birmingham, Sorbonne University, and Harvard Medical School contributed to the article in Neurology.

UBNow

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Ogochukwu Aloke is a political journalist with many years experience in the journalism profession. He is a graduate of Philosophy. He likes surfing the Internet, researching for new things and making new friends.

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