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Removal of the thymus gland is widely practiced as long-term therapy for MG. Most patients improve for a period and some may continue improving, while others soon deteriorate again. Josephson reported the complete failure of nutritional and manganese therapy in MG patients who had their thymus removed. Some researchers believe that the great variability of thymectomy outcomes is due to so-called accessory thymuses or pockets of thymus tissue that may be present in the neck area. These will often be sufficient to maintain a reasonable manganese metabolism and, with this, enable an eventual recovery. On the other hand, if all thymus tissue has been removed, then a full recovery may not be possible. However, there is cautious optimism that even then, a holistic approach can still lead to considerable improvement and to some regrowth of any remaining traces of thymus tissue. Also, the removal of the thyroid makes a cure more difficult, as one of Josephson's case histories shows. In addition to enlargement and tumors of the thymus, MG patients frequently have problems with other endocrine glands such as the thyroid, pituitary, and adrenal glands. There is a close relationship between the thymus and the thyroid in that hyperthyroidism generally leads to myasthenia gravis or muscular debility, as well as to hyperplasia of the thymus. As the disease progresses, most or all of the endocrine glands, organs, and metabolic functions tend to deteriorate. This, then, requires in addition to manganese therapy individualized support with a wide range of nutrients and remedies as well as a diet of highest quality.
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