The thymus gland in adults is symptoms of a pathological process. What to do if a child’s thymus gland is enlarged

People don't know everything about their body. Many people know where the heart, stomach, brain and liver are located, but few people know the location of the pituitary gland, hypothalamus or thymus. However, the thymus or thymus gland is the central organ and is located in the very center of the sternum.

Thymus gland - what is it?

The iron got its name due to its shape resembling a two-pronged fork. However, this is what a healthy thymus looks like, while a sick one takes on the appearance of a sail or butterfly. Because of its proximity to the thyroid gland, doctors used to call it the thymus gland.What is the thymus?This is the main organ of vertebrate immunity, in which the production, development and training of T-cells of the immune system occurs. The gland begins to grow in a newborn baby before the age of 10, and after the 18th birthday it gradually decreases. The thymus is one of the main organs for the formation and activity of the immune system.

Where is the thymus gland located?

You can detect the thymus gland by placing two folded fingers on the upper part of the sternum below the clavicular notch.Location of the thymusthe same in children and adults, but the anatomy of the organ has age-related characteristics. At birth, the weight of the thymus organ of the immune system is 12 grams, and by puberty it reaches 35-40 g. Atrophy begins at approximately 15-16 years. By the age of 25, the thymus weighs about 25 grams, and by 60 it weighs less than 15 grams.

By the age of 80, the weight of the thymus gland is only 6 grams. By this time, the thymus becomes elongated, the lower and lateral sections of the organ atrophy, which are replaced by adipose tissue. Official science does not explain this phenomenon. This is the biggest mystery in biology today. It is believed that lifting this veil will allow people to defy the aging process.

Structure of the thymus

We have already found out where the thymus is located.Structure of the thymus glandLet's look at it separately. This small-sized organ has a pinkish-gray color, soft consistency, and lobular structure. The two lobes of the thymus are completely fused or tightly adjacent to each other. The upper part of the organ is wide, and the lower part is narrower. The entire thymus gland is covered with a capsule of connective tissue, under which there are dividing T-lymphoblasts. The bridges that extend from it divide the thymus into lobules.

The blood supply to the lobular surface of the gland comes from the internal mammary artery, thymic branches of the aorta, branches of the thyroid arteries and the brachiocephalic trunk. Venous outflow of blood occurs through the internal mammary arteries and branches of the brachiocephalic veins. The growth of various blood cells occurs in the tissues of the thymus. The lobulated structure of the organ contains the cortex and medulla. The first appears as a dark substance and is located on the periphery. Also, the cortex of the thymus gland contains:

hematopoietic cells of the lymphoid series, where T-lymphocytes mature;
hematopoietic macrophages, which contain dendritic cells, interdigitating cells, typical macrophages;
epithelial cells;
supporting cells that form the blood-thymus barrier, which form the tissue framework;
stellate cells – secrete hormones that regulate the development of T cells;
“nanny” cells in which lymphocytes develop.

In addition, the thymus secretes the following substances into the bloodstream:

thymic humoral factor;
insulin-like growth factor-1 (IGF-1);
thymopoietin;
thymosin;
Thymalin.

What is he responsible for?

Thymus forms all body systems in a child, and maintains good immunity in an adult.What is the thymus responsible for?in the human body? The thymus gland performs three important functions: lymphopoietic, endocrine, and immunoregulatory. It produces T-lymphocytes, which are the main regulators of the immune system, that is, the thymus kills aggressive cells. In addition to this function, it filters the blood and monitors the outflow of lymph. If any malfunction occurs in the functioning of the organ, this leads to the formation of oncological and autoimmune pathologies.

In children

In a child, the formation of the thymus begins in the sixth week of pregnancy.Thymus gland in childrenup to a year is responsible for the production of T-lymphocytes by the bone marrow, which protect the child’s body from bacteria, infections, and viruses. An enlarged thymus gland (hyperfunction) in a child does not have the best effect on health, as it leads to a decrease in immunity. Children with this diagnosis are susceptible to various allergic manifestations, viral and infectious diseases.

In adults

The thymus gland begins to involute as a person ages, so it is important to maintain its functions in a timely manner. Rejuvenation of the thymus is possible with a low-calorie diet, taking the drug Ghrelin and using other methods.Thymus gland in adultstakes part in modeling two types of immunity: cellular type response and humoral response. The first forms the rejection of foreign elements, and the second manifests itself in the production of antibodies.

Hormones and functions

The main polypeptides produced by the thymus gland are thymalin, thymopoietin, and thymosin. They are proteins by nature. When lymphoid tissue develops, lymphocytes are able to take part in immunological processes.Thymus hormones and their functionshave a regulatory effect on all physiological processes occurring in the human body:

reduce cardiac output and heart rate;
slow down the functioning of the central nervous system;
replenish energy reserves;
accelerate the breakdown of glucose;
increase the growth of cells and skeletal tissue due to enhanced protein synthesis;
improve the functioning of the pituitary gland and thyroid gland;
exchange vitamins, fats, carbohydrates, proteins, and minerals.

Hormones

Under the influence of thymosin, lymphocytes are formed in the thymus, then, with the help of thymopoietin, the blood cells partially change their structure to ensure maximum protection for the body. Timulin activates T-helper and T-killer cells, increases the intensity of phagocytosis, and accelerates regeneration processes.Thymus hormonesparticipate in the work of the adrenal glands and genital organs. Estrogens activate the production of polypeptides, while progesterone and androgens inhibit the process. A glucocorticoid produced by the adrenal cortex has a similar effect.

Functions

In the tissues of the thymus gland, blood cells proliferate, which enhances the body’s immune response. The resulting T-lymphocytes enter the lymph, then colonize the spleen and lymph nodes. Under stressors (hypothermia, starvation, severe injury, etc.)thymus functionsweaken due to massive death of T-lymphocytes. After this, they undergo positive selection, then negative selection of lymphocytes, then regenerate. The functions of the thymus begin to decline by the age of 18, and fade almost completely by the age of 30.

Diseases of the thymus gland

As practice shows,thymus diseasesare rare, but are always accompanied by characteristic symptoms. The main manifestations include severe weakness, enlarged lymph nodes, and a decrease in the body’s protective functions. Under the influence of developing diseases of the thymus, lymphoid tissue grows, tumors form, which cause swelling of the extremities, compression of the trachea, borderline sympathetic trunk or vagus nerve. Malfunctions of the organ appear when the function decreases (hypofunction) or when the thymus functions increase (hyperfunction).

Magnification

If the ultrasound photo showed that the central organ of lymphopoiesis is enlarged, then the patient has thymic hyperfunction. Pathology leads to the formation of autoimmune diseases (lupus erythematosus, rheumatoid arthritis, scleroderma, myasthenia gravis).Thymic hyperplasiaIn infants it manifests itself in the following symptoms:

decreased muscle tone;
frequent regurgitation;
weight problems;
heart rhythm disturbances;
pale skin;
profuse sweating;
enlarged adenoids, lymph nodes, tonsils.

Hypoplasia

The central organ of human lymphopoiesis may have congenital or primary aplasia (hypofunction), which is characterized by the absence or weak development of thymic parenchyma. Combined immunological deficiency is diagnosed as congenital DiGeorge disease, in which children experience heart defects, seizures, and abnormalities of the facial skeleton. Hypofunction orthymic hypoplasiacan develop against the background of diabetes mellitus, viral diseases or alcohol consumption by a woman during pregnancy.

Tumor

Thymomas (tumors of the thymus) occur at any age, but most often such pathologies affect people from 40 to 60 years of age. The cause of the disease has not been established, but it is believed thatmalignant tumor of the thymusarises from epithelial cells. It was noticed that this phenomenon occurs if a person suffered from chronic inflammation or viral infections or was exposed to ionizing radiation. Depending on which cells are involved in the pathological process, the following types of thymus gland tumors are distinguished:

spindle cell;
granulomatous;
epidermoid;
lymphoepithelial.

Symptoms of thymus disease

When the functioning of the thymus changes, an adult feels breathing problems, heaviness in the eyelids, and muscle fatigue. Firstsigns of thymus disease– this is a long-term recovery from the simplest infectious diseases. When cellular immunity is impaired, symptoms of a developing disease begin to appear, for example, multiple sclerosis, Graves' disease. If there is any decrease in immunity and corresponding symptoms, you should immediately contact a doctor.

Thymus gland - how to check

If a child has frequent colds that turn into severe pathologies, there is a high predisposition to allergic processes, or enlarged lymph nodes, then it is necessarydiagnosis of the thymus gland. For this purpose, a sensitive ultrasound machine with high resolution is required, since the thymus is located near the pulmonary trunk and atrium, and is covered by the sternum.

If hyperplasia or aplasia is suspected after a histological examination, the doctor may refer you for a computed tomography scan and examination by an endocrinologist. A tomograph will help identify the following pathologies of the thymus gland:

MEDAC syndrome;
DiGeorge syndrome;
myasthenia gravis;
thymoma;
T-cell lymphoma;
pre-T-lymphoblastic tumor;
neuroendocrine tumor.

Norms

In a newborn baby, the size of the thymus gland is on average 3 cm wide, 4 cm long and 2 cm thick. Averagenormal thymus sizepresented in the table:

Age	Width(cm)	Length(cm)	Thickness(cm)
1-3 months
10 months – 1 year
2 years
3 years
6 years

Pathology of the thymus

When immunogenesis is disrupted, changes in the gland are observed, which are represented by diseases such as dysplasia, aplasia, accidental involution, atrophy, hyperplasia with lymphoid follicles, thymomegaly. Oftenthymus pathologyassociated either with an endocrine disorder, or with the presence of an autoimmune or oncological disease. The most common cause of a decline in cellular immunity is age-related involution, in which there is a deficiency of melatonin in the pineal gland.

How to treat the thymus gland

As a rule, thymus pathologies are observed up to 6 years of age. Then they disappear or develop into more serious diseases. If a child has an enlarged thymus gland, then he should be observed by a phthisiatrician, immunologist, pediatrician, endocrinologist and otolaryngologist. Parents should monitor the prevention of respiratory diseases. If symptoms such as bradycardia, weakness and/or apathy are present, urgent medical attention is required.Treatment of the thymus glandin children and adults it is carried out medically or surgically.

Drug treatment

When the immune system is weakened, biologically active substances must be administered to maintain the body. These are the so-called immunomodulators that are offered bythymus therapy. Treatment of the thymus gland in most cases is carried out on an outpatient basis and consists of 15-20 injections, which are administered into the gluteal muscle. The treatment regimen for thymus pathologies may vary depending on the clinical picture. In the presence of chronic diseases, therapy can be carried out for 2-3 months, 2 injections per week.

5 ml of thymus extract isolated from animal thymus gland peptides is injected intramuscularly or subcutaneously. This is a natural biological raw material without preservatives or additives. After just 2 weeks, improvements in the patient’s general condition are noticeable, since protective blood cells are activated during the treatment process. Thymus therapy has a long-term effect on the body after therapy. A repeat course can be carried out after 4-6 months.

Operation

Thymectomy or thymus removalprescribed if the gland has a tumor (thymoma). The operation is performed under general anesthesia, which keeps the patient asleep throughout the operation. There are three methods of thymectomy:

Transsternal. An incision is made in the skin, after which the sternum bone is separated. The thymus is separated from the tissues and removed. The incision is closed with staples or stitches.
Transcervical. An incision is made along the lower part of the neck, after which the gland is removed.
Video-assisted surgery. Several small incisions are made in the superior mediastinum. A camera is inserted through one of them, displaying an image on a monitor in the operating room. During the operation, robotic manipulators are used that are inserted into the incisions.

Diet therapy

Diet therapy plays an important role in the treatment of thymus pathologies. Your diet should include foods rich in vitamin D: egg yolk, brewer's yeast, dairy products, fish oil. It is recommended to eat walnuts, beef, and liver. When developing a diet, doctors advise including in the diet:

parsley;
broccoli, cauliflower;
oranges, lemons;
sea buckthorn;
rosehip syrup or decoction.

Traditional treatment

To improve immunity, children's doctor Komarovsky advises warming up the thymus gland with the help of a special massage. If an adult has an unreduced gland, then he should support the immune system for prevention by taking herbal infusions with rose hips, black currants, raspberries, and lingonberries.Treatment of the thymus with folk remediesIt is not recommended to carry out this procedure, since the pathology requires strict medical supervision.

Video

The thymus gland (thymus, thymus) is the central organ of the vertebrate immune system. Located in the chest cavity in the anterior mediastinum, slightly above the pericardium. In newborns, this gland is large, reaches the fourth rib and is attached at the level of the sternum.

This is an organ that increases in size until the age of 10, and begins to decrease after the age of 18. The thymus is definitely one of the most important and necessary organs for the formation and functioning of the human immune system.

There is a congenital deficiency of the function of the thymus gland, its dystopia (when the thymus is not in its place).

Sometimes this gland is completely absent. In its absence or when its function is impaired, cellular immunity may also be impaired. As a result, human resistance to infectious diseases decreases.

In addition, autoimmune diseases can also appear, when the immune system does not recognize the cells of its body, begins to attack them and, finally, destroys the tissues of the person’s body. Autoimmune diseases also include myasthenia gravis (a disease of the nervous and muscular system, manifested by weakness and rapid muscle fatigue), various thyroid diseases, rheumatoid arthritis, multiple sclerosis, etc.

When the functioning cellular immunity of T-lymphocytes is disrupted, malignant tumors appear more often. Infections, poor nutrition, and radiation can cause the thymus gland to involute, where it shrinks (reduces in size). Sudden infant death syndrome is known, the possible cause of which is insufficient activity of the thymus.

Symptoms

Symptoms depend on their cause: dysfunction of the immune system, autoimmune disease, tumor.
Reduced resistance to infectious diseases.
Muscle fatigue.
“Heavy” eyelids.
Breathing problems.

Causes

Disorders of the function of the thymus gland can be congenital, or they can also manifest themselves as a result of damage to thymus tissue by radioactive rays. Unfortunately, the reasons most often remain unknown.

The main symptom is frequent various infectious diseases. Loss of function of the T-lymphocyte system is diagnosed by laboratory tests, for example, when the AIDS virus occurs, the T-lymphocytes of a certain subgroup in the body sharply decrease. In autoimmune diseases, the thymus often becomes enlarged and resembles a tumor. An enlarged thymus can be diagnosed by taking an x-ray or examining it with an ultrasound. Often the thymus is removed, the condition of patients usually improves, and occasionally they completely recover. Malignant tumors also occur.

Treatment

Different diseases of the thymus gland are treated differently. Sometimes it is possible to cure simply by removing the enlarged thymus. In addition, there are various medications, although they are not always effective. In severe cases, the patient must be isolated, thereby minimizing the risk of possible infection.

It is necessary to consult a doctor for frequently recurring infectious diseases.

The doctor will thoroughly examine the patient and perform the necessary laboratory and x-ray studies.

Treatment will be prescribed in accordance with the symptoms of the disease.

When the function of the immune system is impaired, a person becomes less resistant to all types of infectious pathologies.

In addition, the course of an autoimmune disease is often unfavorable.

If you often suffer from various infectious diseases, you may have a compromised immune system, so consult a doctor immediately.

The strength of the immune system depends on many factors. The condition of the thymus gland affects the level of the body's defenses and the ability to resist foreign agents. If the functioning of the thymus gland is disrupted, viruses, pathogenic bacteria, and pathogenic fungi spread unhindered through the tissues, and severe infectious diseases develop.

How dangerous is damage to the thymus gland in young children? What thymus pathologies occur in adults? What to do for thymus diseases? The answers are in the article.

Thymus gland: what is it?

For a long time, doctors cannot come to a consensus on which system the thymus belongs to: lymphoid or endocrine. This circumstance does not reduce the role of the gland, which performs an active protective function. Experiments on animals have shown that when the thymus is removed, foreign agents do not encounter resistance, quickly penetrate the cells, and it is difficult for the body to cope with a dangerous infection.

During the first 12 months after the birth of a child, it is the thymus that protects the body from the influence of pathogenic microorganisms. As it grows and develops, other organs take over some of its functions.

From the bone marrow, stem cells periodically move to the thymus, and then the process of their transformation begins. It is in the thymus gland that the formation, “training” and active movement of T-lymphocytes - immune cells - occurs. Differentiation in the tissues of the thymus makes it possible to obtain specific cells that fight foreign agents, but do not destroy elements of their own body. When the thymus malfunctions, autoimmune pathologies develop, when the body perceives its own cells as foreign and attacks them, which leads to malfunctions and severe damage.

Where is the thymus gland located? Most likely, not everyone knows the answer to the question. An important organ, without which the production of T-lymphocytes is impossible, is mentioned less often than the thyroid gland or pituitary gland, but without the thymus, the body becomes practically defenseless against the penetration of dangerous bacteria and viruses.

The thymus gland is easy to identify on x-ray, in the upper part of the chest (a dark spot in the upper mediastinum, just behind the sternum). In case of anomalies in the development of an important organ responsible for the strength of the immune system, individual lobules grow into the tissue of the thyroid gland, found in the area of the tonsils, soft tissues of the cervical region, fatty tissue of the posterior (less often) or anterior (more often) mediastinum. Aberrant thymus is detected in 25% of patients, in most cases females are affected.

Occasionally, doctors record ectopia of the thymus in newborns. Pathology occurs on the left side of the mediastinum, more often in boys. Cardiologists note: with ectopia of the thymus, 75% of patients have congenital defects of the heart muscle.

Functions

The main function of the thymus gland is to produce T-lymphocytes to protect the body. The thymus not only produces specific cells, but also selects them in order to destroy dangerous microorganisms.

Other features:

production of thymus hormones (thymopoietin, IGF-1, thymosin, thymalin), without which the proper functioning of all organs and systems is impossible;
participates in the functioning of the hypothalamic-pituitary system;
maintains immune defense at a high level;
responsible for optimal rates of skeletal growth;
Thymus hormones exhibit a nootropic effect, reduce anxiety levels, and stabilize the functional activity of the central nervous system.

Important! Hypofunction of the thymus gland negatively affects the immune defense: the organ produces fewer T-lymphocytes or, in this type of pathology, the cells are not sufficiently differentiated. In children under one year of age, the thymus gland is large; the organ grows before puberty. With aging, the thymus gland decreases; in extreme old age, a specific organ often merges with adipose tissue; the weight of the thymus gland is only 6 g. For this reason, the strength of the immune system in older people is much lower than in young people.

Structure

The organ has a lobed surface, soft consistency, and a grayish-pink tint. A capsule of connective tissue of sufficient density has two lobes adjacent or fused to each other. The upper element is narrow, the lower one is wide. The name of the organ appeared against the background of the similarity of the upper lobe with a two-pronged fork.

Other parameters: width, on average, 4 cm, length of an important organ - 5 cm, weight - up to 15 g. By 12-13 years, the thymus becomes larger, longer - up to 8-16 cm, weight - from 20 to 37 g.

Causes of thymus problems

In some patients, doctors identify congenital anomalies of the thymus: the action of T-lymphocytes is aimed at destroying not foreign agents, but cells of the body’s own. Chronic autoimmune pathologies negatively affect the patient’s condition, the body weakens, at the same time, bacteria and dangerous viruses multiply unhindered in the tissues after a person is infected. Constant use of medications is required to prevent severe consequences against the background of weak immunity.

Other causes of thymus dysfunction:

exposure to high doses of ionizing radiation;
genetic predisposition;
difficult environmental conditions in the region of residence;
non-compliance by the pregnant woman with the rules of taking medications, irradiation during fetal development.

Learn about symptoms in women, as well as treatment options for the pathology.

There is a page on how to take the hormonal drug Duphaston when planning a pregnancy.

Go to the address and read about the first signs of ovarian inflammation in women, as well as the features of treatment for the disease.

Diseases

If there are frequent colds or a sharp decrease in immunity in newborns, doctors recommend examining the thymus gland in children. It is this organ that is responsible for the level of the body’s defenses at an early age. In case of severe damage to the thymus, doctors recommend removing the problematic organ that does not produce healthy T-lymphocytes. For mild to moderate disorders in the structure and function of the thymus gland, a course of immunomodulators will be required to maintain an optimal level of immunity.

Pathological processes in the thymus occur both in childhood and in adult patients. Dysfunction is often combined with autoimmune lesions of the thymus gland. Damage to an important organ also occurs against the background of a malignant tumor process and hematological diseases.

Diseases of the thymus develop much less frequently than lesions of other organs that regulate basic processes in the body and produce hormones. Pathologies of the hypothalamus, ovaries, pituitary gland, and thyroid gland are more common, especially in patients of middle and older age (40 years or more).

Main types of thymus lesions:

benign and malignant tumors. Types: lymphomas, germinal formations, carcinomas. In childhood, the tumor process occurs rarely; most cases of pathologies were recorded in women and men at 40 years of age and later. In rare cases, biologically benign neoplasms have areas of cystic necrosis;
congenital pathologies. DiGeorge syndrome has several features: congenital hypoparathyroidism, defects of the arteries, veins and heart muscle, glandular aplasia with lack of T-lymphocyte selection. At an early age, the risk of death in children from tetany (severe convulsive seizures) is increased; as the child grows up, the child’s body is faced with persistent and recurrent infectious diseases;
thymic hyperplasia. Neuromuscular pathology occurs with disruption of the process of impulse transmission through myoneural connections from autoantibodies to acetylcholine receptors. With hyperplasia, lymphoid follicles appear in the tissues of the gland. Similar pathological changes develop in many autoimmune diseases: rheumatoid arthritis, multiple sclerosis, Graves' disease;
thymus cysts. Tumor formations most often do not show characteristic signs indicating a pathological process in the thymus, which complicates the timely detection of cysts. In most cases, cavities with mucous and serous contents are identified during surgical treatment. The diameter of cystic formations rarely reaches 4 cm; tumor-like structures are spherical or branching.

Treatment of pathologies of the thymus gland is a long process. Chronic autoimmune diseases cannot be eliminated, you can only reduce the level of negative effects of T-lymphocytes on the body's cells. Taking immunomodulators and B vitamins increases resistance to infections and normalizes nervous regulation.

The thymus gland is an important organ of the endocrine system. In case of immunological disorders, you need to take medications prescribed by your doctor to reduce the risk of destruction of healthy cells. If a child in the first year of life is often sick, it is necessary to check the condition of the thymus gland to exclude congenital autoimmune pathologies. Regular intake of vitamins, proper nutrition, preventive measures in the autumn-winter period, and hardening help strengthen the immune system.

In the following video, a specialist will clearly explain what the thymus gland is and why it is needed in the human body, and will also instruct on what to do if the doctor talks about an enlarged thymus:

V. L. Manevich, V. D. Stonogin, T. N. Shirshova, I. V. Shuplov, S. V. Momotyuk

II Department of Clinical Surgery (headed by Professor Timofey Pavlovich Makarenko) of the Central Institute for Advanced Medical Studies at the Central Clinical Hospital No. 1MPS.

The publication is dedicated to the memory of Vasily Dmitrievich Stonogin (1933-2005)

Diseases of the thymus gland are studied by doctors of various specialties: neurologists, endocrinologists, immunologists, hematologists, surgeons, pathohistologists, etc. The problem of myasthenia gravis is relatively studied; In recent years, the participation of the thymus gland in such a vital process as the development (regulation) of immunity has been established.

Tumors and cysts of the thymus gland, myasthenia gravis and some autoimmune diseases require surgical treatment. A significant contribution to this complex section was made by domestic and foreign surgeons (A. N. Bakulev and R. S. Kolesnikova; V. R. Braitsev; B. K. Osipov; B. V. Petrovsky; M. I. Kuzin et al. ; S. A. Gadzhiev and V. Vasiliev, etc.).

From 1966 to 1973, we observed 105 patients with various diseases of the anterior mediastinum, 66 of them with various diseases of the thymus. These patients were divided into the following clinical groups: 1st - 30 patients with thymic hyperplasia and myasthenia gravis; 2nd - 23 patients with tumors of the thymus gland (thymomas), of which 15 were benign, including 9 with symptoms of myasthenia; with malignant 8, including symptoms of myasthenia 5; 3rd - 4 patients with thymus cysts, all without myasthenia; 4th - 3 patients with teratoid formations; 13th - 2 patients - lymphogranulomatosis with isolated damage to the thymus gland; 6th - 4 patients with aplastic anemia due to autoimmune aggression of the thymus gland.

Of the 66 patients, 65 were operated on: 62 underwent radical and 3 exploratory operations.

There were 44 patients with myasthenia gravis under our supervision, of which 43 (13 men and 30 women) underwent surgery; The age of those operated on was from 14 to 55 years, and the age of the majority (25 patients) was from 15 to 30 years. Among patients with thymus tumors, 30-40 year olds predominated (13 patients).

Myasthenia gravis is a complex neuroendocrine disease, the main manifestation of which is weakness and especially rapid, pathological muscle fatigue after physical activity. Along with this, according to studies by a number of authors (M. I. Kuzin et al., etc.), with myasthenia, the function of many organs and systems (cardiovascular, respiratory, digestive, metabolic, etc.) is disrupted. .

The clinical picture of myasthenia gravis is well known, but the correct diagnosis of a patient with myasthenia is often made after long-term observation. In 32 of our 44 patients, the correct diagnosis was made only 6-8 months after the first signs of the disease appeared. This is explained by the low severity of the clinical picture of myasthenia gravis in the initial stage and the poor awareness of practitioners to whom patients with myasthenia gravis first turn for help (neurologists, ophthalmologists, otolaryngologists, therapists).

With a severe generalized form of myasthenia, the diagnosis is not difficult. In the initial stage and in cases where myasthenia gravis is localized (bulbar, ocular, musculoskeletal, pharyngeal-facial), a wide variety of diagnoses were assumed in our patients, up to suspicion of malingering. We consider it necessary to emphasize the special importance of the proserine test, which has differential diagnostic value. In patients with myasthenia gravis, an intramuscular injection of 1-2 ml of a 0.05% solution of proserin eliminates muscle weakness and fatigue, while in case of myopathies and muscle weakness caused by other causes, the injection of proserin has no effect. Dynamometry, ergometry and electromyography are important.

It is generally accepted that treatment of myasthenia gravis should be carried out comprehensively with the participation of 3-4 specialists: a neurologist, an endocrinologist, an anesthesiologist-resuscitator and a surgeon. Based on large clinical material (hundreds of those operated on and observed in the long-term period), the authors emphasize the advantage of surgical treatment of myasthenia gravis over conservative treatment (M. I. Kuzin; A. S. Gadzhiev et al., etc.). The results of surgical treatment are better if the operation is performed for the first time 2-2.5 years from the onset of the disease. At a later date, the operation turns out to be less effective. This implies the particular importance of early diagnosis of myasthenia gravis.

Of the 43 patients we operated on, only 12 were admitted in the first year of myasthenia, 23 were admitted between 1 and 3 years, and 8 patients were admitted after 3 years. Consequently, patients arrived at the clinic for surgical treatment late.

A special method for studying the thymus gland is radiopaque - pneumomediastinography, which allows one to judge the degree of enlargement of the thymus gland, its structure - a separate node with clearly defined contours or a tumor with infiltrating growth, etc.

The presence of a pronounced clinical picture of progressive myasthenia gravis in a patient is an indication for surgery, since all conservative treatment methods, including radiotherapy, provide only temporary improvement.

Patients with myasthenia gravis require special preoperative preparation, the purpose of which is to reduce the manifestations of myasthenia gravis by individually selecting the dose of medications. Dosages of drugs are selected strictly individually, so that no periods of myasthenic exhaustion are observed during the day, and no myasthenic crisis occurs. Preoperative preparation, being symptomatic therapy, has some therapeutic effect, which has a positive effect on the upcoming operation. However, preoperative preparation, despite its complexity and intensity, is not effective in all patients.

The question of the need for preoperative radiotherapy cannot be considered finally resolved. Only 5 of our patients received x-ray irradiation before surgery, and we did not notice any improvements in them during the postoperative period. In patients operated on for malignant thymoma with myasthenia gravis, preoperative irradiation plays an important role in the immediate outcome of the operation and to some extent influences the timing of relapse of the disease (M. I. Kuzin et al.).

We performed most operations for myasthenia gravis from the anterior approach through a complete median longitudinal sternotomy. The most crucial moment of the operation is the separation of the gland from the left brachiocephalic vein. Injury to this vessel is dangerous due to massive bleeding and possible air embolism. In one case, this vein was injured, which ended successfully (a lateral vascular suture was applied). During surgery, you should avoid applying clamps to glandular tissue or crushing it.

Three of our patients had a combination of myasthenia gravis and substernal goiter. Thymectomy and subtotal strumectomy were performed.

In 26 patients, the mediastinal pleura was damaged during surgery, including 8 patients on both sides. There were no complications associated with surgical pneumothorax. If the pleura is not damaged during the operation, the anterior mediastinum is drained with one rubber tube, the end of which is brought out into the lower corner of the wound or through a separate puncture below the xiphoid process and connected to suction. Following thymectomy, tracheostomy was performed (preventively) in 5 patients.

If the thymectomy operation itself, compared to other thoracic operations, is not particularly difficult, then the course of the postoperative period in a number of patients is accompanied by complications, the first place among which is myasthenic crisis. Therefore, operations for myasthenia gravis are possible only in those institutions where it is possible to provide round-the-clock supervision by an anesthesiologist-resuscitator, as well as multi-day mechanical ventilation.

The issue of prescribing anticholinesterase drugs in the postoperative period has not been completely resolved. In order to reduce bronchial hypersecretion, it is better to prescribe prozerin with small doses of atropine.

Severe myasthenic crisis with disturbances in breathing, cardiac activity, swallowing, etc. was observed in the first days after surgery in 26 patients. 7 patients were brought out of the crisis by conservative measures; 19 patients had a tracheostomy and were transferred to mechanical breathing, the duration of which ranged from 3 to 40 days. Through the tracheostomy, mucus from the tracheobronchial tree is systematically aspirated around the clock. Patients on mechanical breathing are fed through a feeding tube. In addition to drug treatment, the use of oxygen, and the use of breathing exercises, in recent years, all patients with myasthenia gravis in the postoperative period have been given a therapeutic massage of the whole body, repeated several times a day.

The tracheostomy tube is removed after the patient has steadily regained spontaneous breathing.

Of 43 patients operated on for myasthenia gravis, 3 patients died in the first days after surgery. This dates back to the period when the clinic was just mastering these operations. All patients were operated on in serious condition. Long-term results were monitored in 26 patients: recovery occurred in 17 and improvement (patients were taking anticholinesterase drugs) in 8 patients; the condition remained unchanged in 3 patients. Two operated patients died from relapse of malignant thymoma (one with symptoms of myasthenia gravis after 3 years, the other with myocardial infarction).

Benign tumors of the thymus gland (thymomas) are rounded nodes with a dense capsule. Histological examination in these tumors, along with connective tissue cells, reveals fibroblasts and concentrically located elongated epithelial cells resembling Hassal's bodies. These tumors resemble sclerosing angioma in structure and are also called reticular perithelioma (Pope and Osgood). Lipothymomas occupy a special place. Some authors classify them as benign tumors, others as malignant (Andrus and Foot). These tumors often reach large sizes and consist of adipose lobular tissue containing accumulations of thymocytes and Hassalian bodies. If the tumor is dominated by adipose tissue, it is recommended to call it lipothymoma; if elements of the thymus gland predominate, it is called thymolipoma.

Among our patients, we observed 3 (2 men and 1 woman, all over 40 years old) with lipothymoma. Their tumor was small in size, with smooth, clear boundaries; The tumor was regarded by us as benign. The disease was accompanied by moderately severe symptoms of myasthenia gravis. One of these patients was admitted with complaints of weakness and fatigue; Upon further examination, he was diagnosed with severe hypoplastic anemia. The patient has been operated on; Favorable results were noted in the immediate postoperative period.

Of our 15 patients with benign thymomas, 9 (4 men and 5 women) had symptoms of myasthenia gravis; in the rest, the tumor did not manifest itself in any way and was discovered by chance.

Malignant thymomas are dense, lumpy tumors of various sizes, often growing into the capsule. In patients with these neoplasms, due to the rapid growth of the tumor, invasion of neighboring organs or compression of them, mediastinal compression syndrome early develops. Patients complain of chest pain, a feeling of pressure in the chest, etc. Malignant thymomas often occur with symptoms of myasthenia gravis, which we noted in 5 out of 8 patients. Malignant thymoma can be completely asymptomatic. Here's an example.

Patient M., 19 years old, was admitted on March 17, 1966. No complaints. After graduating from high school, while undergoing a medical examination for admission to an educational institution, he was radiologically diagnosed with a tumor formation in the anterior mediastinum. There are no signs of myasthenia gravis. Pneumomediastinography: in the anterior mediastinum on all sides there is an oblong formation, 15*5 cm in size, enveloped in gas, with areas of clearing in the center; conclusion: tumor of the thymus, possibly with areas of decay. A thymectomy was performed. Histologically: malignant thymoma of the retinocellular type. Postoperative radiotherapy was performed. Examined 4 years after surgery: no complaints, good condition, no signs of relapse.

Differential diagnosis of benign and malignant thymomas is often difficult. Malignant thymoma has radiographic features that resemble lymphogranulomatosis and lymphosarcoma. In contrast to these formations, thymoma is located directly behind the sternum and is usually oval-flattened or cone-shaped. Any thymoma, whether it occurs with or without myasthenia gravis, must be removed. There are indications in the literature that every thymoma should be considered as a potentially malignant tumor (B.V. Petrovsky; Seybold et al., etc.).

Thymus cysts are quite rare. Usually these are thin-walled formations of various sizes, located in the thickness of the gland, filled with a yellowish or brownish liquid. Due to the elasticity of these formations, there are no signs of compression of surrounding organs. The clinical picture of cysts, if they occur without myasthenia, is poor. As a rule, they are discovered by chance, during a routine examination. All of our 4 patients (3 women and 1 man) were over 40 years old (41 years - 48 years). None of the patients had signs of myasthenia, although combinations of thymic cysts and myasthenia have been described. All were operated on (thymectomy) with a favorable result.

In 3 patients we operated on, the tumor of the anterior mediastinum was a teratoma according to its histological structure. Considering the close connection of the formation with the remnants of the thymus gland and the presence of thymic tissue in the formation itself, we regarded the tumor as a teratoma of the thymus. In 2 patients, based on signs (the appearance of sebaceous masses and hair in the sputum in one patient, as well as the detection of organoid inclusions on an x-ray in another), the diagnosis was made before surgery, in the third patient - only during surgery. Of the 3 operated patients, 2 had to remove not only the teratoid formation, but also a lobe of the lung due to the involvement of the latter in the process (breakthrough of a suppurating teratoma into the upper lobe bronchus). The high degree of malignant transformation of teratoid formations, the possibility of suppuration and other complications convince us of the need for early and radical surgical removal of these tumors.

The question of the possibility of isolated damage to the thymus gland by lymphogranulomatosis seems controversial. We observed 2 patients who were diagnosed with a tumor of the thymus before surgery. After the operation, upon histological examination of the preparations, the diagnosis was changed: isolated lesion of the thymus gland by lymphogranulomatosis. Taking into account the indications about the possibility of isolated damage to the thymus gland in the early stages of the disease (S. A. Gadzhiev and V. V. Vasiliev), we attributed both of these observations to pathology of the thymus gland. After surgery, patients are monitored for 5 years. There are no signs of relapse or generalization of the process.

The disease, which consists of a combination of pathology of the thymus gland and hypoplastic anemia, which occurs as a result of selective damage to the bone marrow without changing the production of leukocytes and platelets, was first described by Katsnelson in 1922. Later it was suggested that the thymus gland influences the hematopoietic function of the bone marrow, regulation of the composition of protein fractions, the state of the lymphoid system, etc. (Soutter et al.). Since then, data from some authors on individual operations on the thymus gland for various blood diseases have been published (A. N. Bakulev, 1958; Chaemers and Boheimer, etc.). To date, we have performed 4 thymectomy operations in patients with hypoplastic anemia. It is too early to talk about the results of these operations, since a short time has passed since them. The immediate results are satisfactory in 3 patients.

Conclusions

A number of pathological processes occur in the thymus gland that require surgical treatment.
Surgical treatment for myasthenia gravis is justified both in the presence of a radiologically and clinically detectable tumor, and only in cases of thymic hyperplasia.
The operation is recommended to be performed as soon as possible after diagnosis. Radiation treatment is advisable to carry out after removal of a malignant tumor or if radical surgery is impossible.

LITERATURE.

1) Bakulev A. N., Kolesnikova R. S. Surgical treatment of tumors and mediastinal cysts. M., 1967.

2) Braitsev V. R. Congenital dysontogenetic formations of the mediastinum and lungs. M., 1960.

3) Gadzhiev S. A., Dogel L. V., Vanevsky V. L. Diagnosis and surgical treatment of myasthenia gravis. L., 1971.

4) Gadzhiev S. A., Vasiliev V. Med newspaper, 1973, No. 15.

5) Kuzin M.I. Klin honey, 1969, No. 11, p. 6.

6) Kuzin M.I., Uspensky L.V., Volkov B.P. Vesti, hir., 1972, No. 7, p. 48.

7) Osipov B.K. Surgical diseases of the lungs and mediastinum. M., 1961.

8) Petrovsky B.V. Surgery of the mediastinum. M., 1960.

9) Andgus W., Foot N., J. thorac. Surg., 1937, v. 6. p. 648.

10) Chaemers G., Boheimer K., Brit. med. J., 1954, v.2, p.1514.

11) Pope R., O s g o o d R., Am. J. Path., 1953, v. 20, p. 85.

12) S e y b o 1 d W., D o n a 1 d M. S., J. thorac. Surg. Clagett C. et al., 1950, v. 20, p.195.

13) Soutter G., Sommers Sh. R e 1 m o n Ch. et al. Ann. Surg., 1957, v. 146, p. 426.

14) Viets H., Brit. med. J., 1950, v. 1, p.139.

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The thymus, thymus or thymus gland in the human body is responsible for the formation of the immune system. Its development and growth continues until about the age of ten, after which it gradually decreases in size. Among the diseases of this organ, inflammation of the thymus gland, its hyperplasia or dystopia are most often noted. The information in our article will help you understand these conditions in more detail.

This important organ is located approximately in the chest area, most often immediately behind the pericardium. In childhood, the gland can shift to the area of the fourth rib, so during diagnosis, its location is immediately determined. The thymus gland is formed in the prenatal state; at birth, its weight can reach 10 grams. After three years, it begins to develop sharply, and reaches its maximum size (about 40 grams) by the period of adolescence at 13–15 years. After this, there is a gradual atrophy of its functions and a decrease in size. If this does not happen, and the thymus gland is detected in an adult, this is also an alarming symptom that requires treatment.

Why is the thymus gland needed?

Formation of the body's natural defense - the immune system.
Development of antibodies to viruses and bacteria.
Renewal of brain cells.

Disturbances in the functioning of this organ are fraught not only with a decrease in protective forces and frequent illnesses. In this case, we are talking about the appearance of autoimmune diseases, when the body “attacks” its internal organs. The risk of tumors and multiple sclerosis increases. Other symptoms of malfunction of this important organ are described below.

Major diseases of the thymus

It is incredibly difficult to diagnose such cases, because the symptoms are similar to other diseases. Persistent infections, increased fatigue and muscle weakness may indicate problems with the thymus. The final diagnosis can only be made by a doctor after examination. The specialist will also determine the true cause and type of problem.