MG & Thyectomy

[Mike-Asel]

    
      Re: MG & Thyectomy
    


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Posted by CCF MD on August 21, 1997 at 12:49:24:

In Reply to: MG & Thyectomy posted by Mike Assel on August 20, 1997 at 22:40:27:

: My father was diagnosed with MG approximately one year ago.  He suffered with double vision, slurred speech, and inability to swallow for months before his HMO accurately diagnosed MG.  He is 59 years old and is currently taking 50 mg of prednisone and working down.  My father is currently experiencing an increase in symptoms and less benefit from his medication regimen.  He has also been having dental work secondary to a recurrent tooth infection.  The tooth will be removed when his bridge work is completed.  My mother and I are concerned about his physican, especially when he asked us to cruise the net to find out if thyecotomies were attempted with 59 year old patients.  My father weighs appx. 220 pounds, practically sedentary, and is working half days because of the fatigue.  Now with the questions:
  1) Is a thyectomy contraindicated in a 59 year old patient?
  2) Is MG common enough that a neurologist in a managed care practice can adequately treat the disorder?  Or would you recommend seeing someone in a specialized clinic or university med. center?
  3) I've read some articles on Medline that suggest that the thyectomy procedure that is done without opening up the sternum has been achieving good results, any thoughts?
  4) Could a recurrent tooth infection play a part in the worsening of symptoms?
  5) At what point would you suggest getting a second opinion?
  Thanks,
  MIKE
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Myasthenia gravis is an autoimmune disorder of the neuromuscular junctions,
characterized by weakness and fatigability of skeletal muscles including visual symptoms.
The diagnosis is based on the history and physical exam, blood work for
acetylcholine receptor antibodies, response to a tensilon test, EMG with
repetitive stimulation. A CT scan of the chest is also done to look for
thymus abnormality.
Treatment involves acetylcholinesterase inhibitors such as mestinon, immunosupression,
surgical thymectomy, and plasmpharesis.
With that as a background let me answer some specific questions.
We are not hear to argue the diagnosis and you should ask your doctor
how the diagnosis was reached. If you are comfortable with the answere
then the question becomes one of treatment.
More than 75% of MG patients have thymus abnormalities. 85% of these
are "hyperplasia", and 15 % are thymomas. Surgical thymectomy has gained
acceptance during the past decade as a treatment for generalized MG.
Some patients have mostly ocular MG and treatment is more controversial.
Remission occurs in 1/3rd of patients with thymectomy. The age cut off for thymectomy is
very controversial. Some institutions use 50 as a cut off, others 60. It
depends on many factors. Thymectomy would not be contraindicated for your
father but he has an increased risk and the likelyhood for cure is much
less than a 30 year old. We recommend the open procedure not the less
invassive procedure for our patients. It also needs to be done at an
institution that has extensive experience with this problem to decrease the
morbidity and mortality.
Steroids increase your risk of infection and any infection can make MG worse.
Some medications (antibiotics) can also make MG worse so speak with your
doctor regarding this.
If you are uncomfortable with your doctor then you need to decide if you
need a second opinion. MG is rare and some doctors will see very few cases of
it during there medical career.
It is very difficult to make recommendations on a patient we have not seen.
It sounds like you need to sit down with your doctor to discuss what we have
be talking about.
Good luck.