Al Tarshihi Thoracic Clinic
Dr. Mohammad Ibrahim Al Tarshihi is a consultant thoracic surgeon with Jordanian Board certification and thoracic and thoracoscopic fellowship training in Germa…
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The thymus is a small organ that sits in the front of the chest behind the breastbone. It is active in childhood and shrinks with age. A thymectomy is surgery to remove the whole gland, together with the surrounding fatty tissue of the anterior mediastinum. It is considered in two main situations: a mass in the gland or the anterior mediastinum that needs removal and a tissue diagnosis, or myasthenia gravis — an immune condition affecting the junction between nerve and muscle that causes weakness worsening with use, drooping eyelids, double vision and difficulty swallowing. In myasthenia, thymectomy is offered as part of a plan intended to improve disease control and reduce medication needs over time. The decision is shared between the thoracic surgeon and the neurologist and depends on clinical assessment, antibody pattern, age and symptom severity — not on reading an article. The operation can be performed in several ways: through a breastbone incision, thoracoscopically from the side of the chest or from below the lower end of the sternum, or robotically in equipped centres. The goal is the same in every approach: to remove all the thymic tissue, not part of it. Preparation differs from other chest operations. Myasthenia should ideally be stable before surgery, so swallowing, breathing and lung function are assessed, and the neurologist may arrange immune treatment beforehand to reduce the risk of a myasthenic crisis afterwards. Anaesthesia is planned with particular care regarding muscle relaxants. The limits must be clear before you consent. Thymectomy is not an instant cure: improvement is gradual and measured over months to years, and myasthenia medication continues after surgery and is reduced — if at all possible — only by decision of your neurologist, so never stop your treatment on your own after the operation. It is not suitable for every subtype of myasthenia, it does not prevent later relapses, and if a thymic tumour is found, further treatment may be added according to the pathology report.
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Procedure steps
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Joint assessment with the neurologist
Symptom history, antibody pattern and nerve-muscle study results are reviewed, and a CT scan of the chest assesses the gland and the mediastinum. How far swallowing and breathing are affected is measured, because this determines the timing of surgery and how safe it is.
- 2
Optimising your condition before surgery
If myasthenia is unstable, surgery is postponed until it improves, and the neurologist may arrange preparatory immune treatment to lower the risk of a postoperative myasthenic crisis. All your medicines are reviewed and the anaesthetic team is alerted to the particular sensitivity to muscle relaxants.
- 3
The resection and the access route
The operation is done under general anaesthesia. The entire gland and surrounding fat are removed through a sternal incision, or thoracoscopically from the side of the chest or from below the lower sternum. The choice depends on the size of the mass, its relationship to vessels and the centre experience. A small drain may be left in place.
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Respiratory monitoring after surgery
Cough strength, swallowing and breathing are monitored closely in the first hours and days, because myasthenia can worsen temporarily after any surgery or infection. Your medicines are restarted on a schedule set by the team, and breathing exercises and walking begin early.
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Follow-up and gradual medication reduction
The pathology report determines whether a thymic tumour is present and needs surveillance or additional treatment. Reducing myasthenia medication happens slowly, over months, and only on your neurologist's decision, with regular assessment of symptoms and muscle strength.
Before the procedure
Give the team a complete list of your medicines and supplements, and keep taking your myasthenia treatment up to the morning of surgery exactly as your doctor instructs. **Do not stop antiplatelet or anticoagulant medication on your own; stopping it is a joint decision between the surgeon and your cardiologist, and that holds even before a tooth extraction or a dental cleaning.** Tell every doctor — including those in other specialties — that you have myasthenia gravis before any new medicine is prescribed, because some antibiotics, some cardiac drugs and magnesium can increase muscle weakness. Report any recent infection, fever, new swallowing difficulty or breathlessness, as these are reasons to postpone. Bring your neurologist's reports and previous imaging, follow the fasting instructions, arrange an escort and an inpatient stay, and start deep breathing exercises beforehand.
After the procedure
Walk and breathe deeply from the first day, use the incentive spirometer as instructed, and care for the wound as directed. If a sternal incision was used, avoid lifting, pushing, pulling and driving for the period your surgeon specifies, and avoid pushing through your chest when getting out of bed. **Go to the emergency department immediately if muscle weakness increases, if an eyelid droops or double vision appears quickly, if you choke on food or fluids or cannot swallow, if your cough becomes weak and your voice quiet, or if you become breathless — this may be a myasthenic crisis needing urgent treatment.** **Seek help urgently as well for high fever, pus or opening of the wound, a sensation of movement or clicking in the breastbone, or pain and swelling in a leg.** Never stop or adjust a medicine yourself after surgery; any reduction is staged and decided by your neurologist.
Expected duration
Usually one and a half to three hours depending on the approach, with a stay of one to two days after a keyhole operation and about four to six days after a sternal incision; improvement in myasthenia continues gradually over months.
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