Effects of thymectomy on multiple sclerosis with myasthenia gravis

Masoud Etemadifar, Omid Mirmosayyeb, Nahid Eskandari


Multiple sclerosis (MS) is the most common chronic autoimmune neuromuscular disease with prevalence rates that has increased in Iran especially in Isfahan population. In MS, there is a coordinated attack of innate and adaptive immune cell against central nervous system (CNS). Concurrence of autoimmune disorders is prevalent such as the concurrence of MS and myasthenia gravis (MG). MS could be associated with MG although they have different target organs. The aim of this study was to assess the effects of thymectomy as a proper treatment for both MS and MG. We studied patients who were referred to our MS clinic with the diagnosis of definite MS and MG made by a neurologist according to Isfahan MS Clinics, Isfahan, Iran (2010-2013). Age, sex, family and medical history, general neurologic symptoms and physical examination in all patients were recorded. We analyzed the clinical, laboratory, and brain magnetic resonance imaging (MRI) findings of the patients with MS and MG in an attempt to identify parameters involved in these diseases. We surveyed 12 patients (0.3%) out of 3920 patients who had both MS and MG. One of these patients had secondary progressive MS and the others had relapsing-remitting MS (RRMS). Five of them experienced thymectomy operation and about 4 (80%) of them completely improved after thymectomy, none of the symptoms of diseases were seen. Almost all of patients completely improved after thymus removal. We suggest thymectomy could be a valuable therapy for MS/ MG patients. However, more investigations should be done on this issue.



Multiple sclerosis, myasthenia gravis, thymectomy

Full Text:



Anderson RG. Multiple endocytic pathways. J Invest Dermatol 99:7S-9S, 1992.

Ahlgren C, A Oden, J Lycke. A nationwide survey of the prevalence of multiple sclerosis in immigrant populations of Sweden. Mult Scl 18:99-107, 2012.

Wallin MT, Culpepper WJ, Coffman P, Pulaski S, Maloni H, Mahan CM, Haselkorn JK, Kurtzke JF. The Gulf War era multiple sclerosis cohort: age and incidence rates by race, sex and service. Brain 135:1778-1785, 2012.

Kilic AK, Kurne AT, Oguz KK, Soylemezoglu F, Karabudak R. Mass lesions in the brain: tumor or multiple sclerosis? Clinical and imaging characteristics and course from a single reference center. Turk Neurosurg 23: 728-735, 2013.

Popescu BF, Pirko I, Lucchinetti CF. Pathology of multiple sclerosis: where do we stand? Continuum. 19: 901-921, 2013.

Bellenberg B, Busch M, Trampe N, Gold R, Chan A, Lukas C. 1H-magnetic resonance spectroscopy in diffuse and focal cervical cord lesions in multiple sclerosis. Eur Radiol 23: 3379-3392, 2013.

Raine CS. Multiple sclerosis: immune system molecule expression in the central nervous system. J Neuropathol Exp Neurol 53: 328-337, 1994.

Noseworthy JH, Lucchinetti C, Rodriguez M, Weinshenker BG. Multiple sclerosis. N Engl J Med 343: 938-952, 2000.

Lucchinetti C, Brück W, Parisi J, Scheithauer B, Rodriguez M, Lassmann H. Heterogeneity of multiple sclerosis lesions: implications for the pathogenesis of demyelination. Ann Neurol 47: 707-717, 2000.

Lorenzoni PJ, Scola RH, Kay CS, Werneck LC. Myasthenia gravis and multiple sclerosis: an uncommon presentation. Arq Neuropsiquiatr 66: 251-253, 2008.

D'Andrea V, Meco G, Corvese F, Baselice PF, Ambrogi V. The role of the thymus in multiple sclerosis. Ital J Neurol Sci 10: 43-48, 1989.

Nikishov VN, Bogdanov EI, Sanadze AG, Sigal EI, Sidnev DV, Dedaev SI, Kondrat'ev AV. Thymectomy and antibodies to acetylcholine receptors (AChR) in patients with myasthe-nia gravis in the early postoperative period. Zh Nevrol Psikhiatr 112: 32-36, 2012.

Sherer Y, Bardayan Y. Thymoma, thymic hyperplasia, thymectomy and autoimmune diseases. Int J Oncol 10: 939-943, 1997.

Constantinescu CS, Gran B. The essential role of T cells in multiple sclerosis: A reappraisal. Biomed J 37: 34-40, 2014.

Waid DM, Schreiner T, Vaitaitis G, Carter JR, Corboy JR, Wagner DH Jr. Defining a new biomarker for the autoimmune component of multiple sclerosis: Th40 cells. J Neuroimmunol 270: 75-85, 2014.

D'Andrea A, Schettini A, Giannattasio F, Di

Francia P, De Vito F. Evaluation of T lymphocytes and lymphocyte subpopulations in patients with pleural effusion. Arch Monaldi Mal Torace 42: 555-561, 1987.

Onodera H. Pathogenesis of myasthenia gravis. No To Shinkei 58: 987-997, 2006.

Gotkine M, Fellig Y, Abramsky O. Occurrence of CNS demyelinating disease in patients with myasthenia gravis. Neurology 67: 881-883, 2006.

Ramanujam R, Zhao Y, Pirskanen R, Hammar-ström L. Lack of association of the CIITA -168A-->G promoter SNP with myasthenia gravis and its role in autoimmunity. BMC Med Genet 11: 147, 2010.

Yin W, Allman W, Ouyang S, Li Y, Li J, Christadoss P, Yang H. The increased expression of CD21 on AchR specified B cells in patients with myasthenia gravis. J Neuroimmuno 256: 49-54, 2013.

Trotter JL, Clark HB, Collins KG, Wegeschiede CL, Scarpellini JD. Myelin proteolipid protein induces demyelinating disease in mice. J Neurol Sci 79: 173-188, 1987.

Ferguson TB, Clifford DB, Montgomery EB, Bruns KA, McGregor PJ, Trotter JL. Thymectomy in multiple sclerosis. Two preliminary trials. J Thorac Cardiovasc Surg 85: 88-93, 1983.

Mulder DG , Herrmann C Jr, Keesey J, Edwards H. Thymectomy for myasthenia gravis. Am J Surg 146: 61-66, 1983.

Haynes BF, Harden EA, Olanow CW, Eisenbarth GS, Wechsler AS, Hensley LL, Roses AD. Effect of thymectomy on peripheral lymphocyte subsets in myasthenia gravis: selective effect on T-cells in patients with thymic atrophy. J Immunol: 131 773-777, 1983.


  • There are currently no refbacks.