Thymectomy (and Myasthenia)

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Thymectomy (and Myasthenia)

Thymectomy is removal of the thymus gland; the gland helps the immune system when you are a child but shrinks with age and may be absent in the elderly. The thymus normally lies in front of your heart, behind the breastbone.

Thymectomy may be recommended because the gland has a tumour in it (thymoma) or to improve the symptoms of myasthenia gravis (MG).

The chances of improvement in symptoms for younger people with MG are:

  • 1 in 4 people improve so much they don’t need medication
  • 2 in 4 people improve but still need some medication
  • 1 in 4 people don’t improve

The thymus gland and nearby fat is removed and sent for analysis. If you have MG your symptoms must be well controlled before surgery.

The surgery can be done in three ways, via a vertical cut on the front of the chest (median sternotomy), keyhole surgery (VATS or robotically) or via a horizontal cut on the front of the neck. For median sternotomy the breastbone is cut in half to see the thymus and remove it. This is the same kind of cut as for heart bypass surgery. At the end of the operation the breastbone is fixed back together with wire. The wound is then stitched back together. Stitches are usually dissolvable. A chest drain may be needed for a short time.

During keyhole surgery (VATS) surgery you lie on your side with your arm raised. 3 small cuts are made, each about 8-12 mm long. These are used for the instruments and small camera to go into the chest to see the thymus. The thymus is removed through one of the small cuts and the wounds are then stitched back together. Stitches are usually dissolvable. A chest drain is usually needed for a short time.

If you have MG you may experience a flare up of symptoms straight after after surgery, this should improve with time.

See sections:

  • Recovery in hospital
  • Recovery at home
  • Pain control
  • Exercise and physiotherapy

You may find your recovery is quicker because you have not had part of the lung removed.  Good posture, breathing exercises and gentle shoulder exercises will help your recovery.

Recovery after sternotomy

If you have a sternotomy there are some extra instructions to follow. These are to reduce stress on the breast bone as it is healing.

  • Support the front of your chest with a cushion or towel when you cough
  • Do not stretch both arms back at the same time
  • Only move arms in a painfree range
  • Keep elbows close to the body during any tasks
  • Do not lie on your side for the first week after surgery
  • Do not carry heavy bags with a strap across your chest for 6 weeks
  • When going from lying down to sitting up: roll on your side, put your feet over the edge of the bed and push up using your elbow. Do this for 6 to 8 weeks.
  • Do no push up from a chair using your arms for 6 to 8 weeks
  • Do not lift/push/pull heavy objects for 3 months

The risks here are a guide; your own risk may vary. You should discuss the risks and benefits of surgery with your surgeon, especially if you are worried.

 General risks of thoracic surgery apply to thymectomy.

There are some risks which are more specific to thymectomy. Your kidneys may not work as well after surgery, but this is usually temporary and gets better with extra fluid. The nerve to the diaphragm runs close to the operation site, there is a risk of injuring this nerve. A further operation may be required to fix this.

Weakness associated with a flare up of MG may affect your breathing. Weakness may severe enough to require help from a ventilator machine. This can be with a face mask with you fully awake. It may also be need via a tube in your windpipe with you under sedation. If you need help breathing via a tube for a long time it may be better to have a temporary tracheostomy. This is a tube put in through the neck which is removed once breathing improves. The risk of death from thymectomy is 7 in 1000 (0.7%) nationally, this means 993 out of 1000 people recover from the surgery.

If you have MG you may continue medication as advised by your hospital doctor

If you have a tumour of the thymus gland options may include:

  • Chemotherapy
  • Radiotherapy
  • Palliative care

It is your choice whether to go ahead with surgery or choose another kind of treatment. We will respect your wishes and support you in choosing the treatment that suits you. You are always welcome to seek a second opinion.

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