At the turn of the Century, abnormalities of the thymus gland were first noted in patients who had the symptoms of Myasthenia Gravis. Since the 1940s, thymectomy (the surgical removal of the thymus gland) has been a part of MG therapy. At the present time, thymectomy is a widely accepted treatment form for many Myasthenics.
The thymus gland is located in the upper chest under the breastbone. It is composed of many small lobes and is shaped somewhat like a butterfly wing over the windpipe. Hormones produced by the thymus gland are thought to affect the immune system and the neuromuscular transmission although the exact role in Myasthenia Gravis is not completely understood.
When a thymectomy is being considered by the MG physician and Myasthenic, a referral is made to a surgeon who has experience of this type of surgery. The surgeon then examines the patient and reviews the various patient records, tests, and x-rays. Once it is decided that a thymectomy may be beneficial, hospital admission and surgical dates are arranged for the patient.
Thymectomy is not a new treatment for MG. Since the early 1940s thymectomies have been performed around the world as part of the treatment for patients with MG. Not everyone diagnosed with MG will undergo a thymectomy. In some treatment centres, surgery is reserved for adolescents and young adults unless a tumour is suspected. Surgery may then be offered regardless of the patients age, so long as he or she is a reasonable surgical candidate.
Part of the preparation before surgery will be a visit from a member of the anaesthesia department. The anaesthetist will want to know about any allergies and about all medications that are being taken, and will then discuss the anaesthesia plan with the patient.
Food and fluids will be withheld after midnight, or on the day of surgery. Routine medication for Myasthenia may or may not be given.
On the morning of surgery, a pre-operative medicine may be given by injection. This medication can cause relaxation, drowsiness, and dryness of the mouth.
After surgery has been completed, a one to three hour stay in the recovery room, or post-anaesthesia room, is required. Once the effect of the anaesthetics has worn off, the patient will be transported to a room in the hospital. In this phase of the recovery, fluids and medication will be given by means of a needle in the vein called an intravenous, or I.V.
After surgery there may be an increase in muscle weakness in some patients. However, through close clinical observation by the health care team, treatment will be adjusted to meet individual needs.
Once fluids are tolerated by the mouth, the intravenous fluids will be stopped. Solid foods will be started slowly, and the patients medication will once more be given by mouth.
Length of stay in the hospital varies for each patient. Thymectomy may lessen the severity of the myasthenic symptoms; however, the degree to which the symptoms are lessened differs in each patient. A slight improvement in muscle strength, or a remission may occur. Remission, which may be either temporary or permanent, is the complete elimination of symptoms without medication.
The following are some of the most common questions that Myasthenics ask about when they consider thymectomy surgery. Since each patients situation is unique, it is essential to remember to discuss any questions about this surgery with your MG physician and surgeon.
These are just a few of the many questions Myasthenics preparing for thymectomy surgery may have. It is encouraging to note that most patients have few problems after this surgery and are able to return to their usual activities relatively quickly. Patients may also have questions after surgery, so it is helpful to keep a paper and pen handy to write these down for further discussion. Doctors and nurses want patients to be as informed as possible and to be involved in their own care because this tends to make patients recover quicker with better outcomes.
The Association does its best to ensure that the information contained in this leaflet is complete and up to date at the time of publication, but cannot accept any legal liability whether for any inaccuracy or otherwise.
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