BrainWaves #54 To thymectomize or not to thymectomize...that is the question

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.

Originally released: March 14, 2019

In 2016, we heard the results of the MGTX trial--a pivotal investigation that demonstrated the efficacy of thymectomy for select patients with non-thymomatous myasthenia gravis. This spring, we saw the long-term follow-up data from the MGTX investigators. In this week's re-run, we summarize these data, critique it, and reflect on how it may change clinical practice.

Produced by James E Siegler. Music courtesy of Scott Holmes and Lee Rosevere. Sound effects by Mike Koenig and Daniel Simion. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. Be sure to follow us on Twitter @BrainWaves audio for the latest updates to the podcast.

REFERENCES

Blalock A, Harvey AM, Ford FR, Lilienthal JL. The treatment of myasthenia gravis by removal of the thymus gland. JAMA 1941;117:1529-33.

Oosterhuis HJ. Observations of the natural history of myasthenia gravis and the effect of thymectomy. Ann N Y Acad Sci 1981;377:678-90. PMID 6951492

Wolfe GI, Kaminski HJ, Aban IB, et al. Randomized trial of thymectomy in myasthenia gravis. N Engl J Med 2016;375(6):511-22. Erratum in: N Engl J Med 2017;376(21):2097. [Dosage error in article text]. PMID 27509100

Wolfe GI, Kaminski HJ, Aban IB, et al. Long-term effect of thymectomy plus prednisone versus prednisone alone in patients with non-thymomatous myasthenia gravis: 2-year extension of the MGTX randomised trial. Lancet Neurol 2019;18(3):259-68. PMID 30692052

We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode’s original release date.