American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with myasthenia gravis and no thymoma, what treatment has shown significant clinical benefit?

1. High-dose glucocorticoids

2. Early thymectomy

3. Plasmapheresis alone

4. Long-term immunosuppressants

The correct answer is: Early thymectomy

In patients with myasthenia gravis who do not have thymoma, early thymectomy has demonstrated significant clinical benefit. Thymectomy, which is the surgical removal of the thymus gland, has been shown to improve symptoms and may lead to remission in some patients with myasthenia gravis. The thymus gland is known to play a role in the immune system, and its removal can reduce the production of autoantibodies against acetylcholine receptors, which is a key issue in myasthenia gravis. Patients frequently experience an improvement in muscle strength and a reduction in the severity of the disease after undergoing this procedure. Thymectomy is particularly beneficial in patients with generalized myasthenia gravis, as it can also reduce the need for medications over time. The timing of the surgery plays a crucial role; earlier intervention tends to yield better outcomes, especially in younger patients. In contrast, treatments such as high-dose glucocorticoids, plasmapheresis, and long-term immunosuppressants can help manage symptoms and control the disease but do not necessarily lead to the same level of improvement or long-term benefits that thymectomy can provide. These therapies are generally used for symptomatic relief rather than offering a