A 50-year-old woman presents with fatigable diplopia, ptosis worsening throughout the day, and limb weakness. Acetylcholine receptor antibodies are positive. CT chest shows a 3 cm anterior mediastinal mass. What is the RECOMMENDED treatment for her thymic pathology?

• A Radiotherapy to the mediastinum
• B Chemotherapy with cisplatin-based regimen alone
• C Observation with pyridostigmine only
• D Thymectomy, as the mass likely represents thymoma associated with MG ✓

Explanation

Thymoma is found in approximately 15% of patients with MG, and all patients with thymoma and MG should undergo thymectomy. Even in the absence of thymoma, the MGTX trial demonstrated that thymectomy in generalised AChR-antibody-positive MG improved clinical outcomes and reduced steroid requirements over 3 years. Radiotherapy alone is insufficient for resectable thymoma. Chemotherapy is reserved for unresectable or metastatic thymoma. Pyridostigmine alone does not address the thymoma.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.