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Background <p>The thymus is critical in the pathogenesis of early-onset myasthenia gravis (EOMG), whereas its involvement in late-onset myasthenia gravis (LOMG) remains controversial. Herein, we systematically analyzed thymic computed tomography (CT) images and evaluated thymic output in patients with LOMG.</p> Results <p>We retrospectively examined the chest CT images and clinical profiles of 59 patients with LOMG, 16 patients with EOMG, and 225 matched controls from our center. These data were acquired at the time of diagnosis and before any immunotherapy. The key CT features, thymic volume, surface area, and density (represented by gray value), were assessed quantitatively and compared between groups. In a separate flow-cytometry cohort, circulating naïve T cells and recent thymic emigrants (RTEs) were analyzed in 20 immunotherapy-naïve LOMG patients and 27 healthy matched controls. Patients with LOMG showed lower thymic gray value and larger thymic volume and surface area compared with controls. Thymic volume was positively correlated with BMI and LOMG patients with diabetes had larger thymus than those without. Multivariate Logistic regression analysis revealed that thymic volume, surface area, and gray value were associated with the risk of LOMG. In the independent flow-cytometry cohort, patients with LOMG also exhibited reduced circulating RTEs, suggesting impaired thymic output.</p> Conclusions <p>Patients with LOMG showed exaggerated thymic involution and reduced thymic output, supporting thymic involvement in the pathophysiology of LOMG. These findings provide clues for future mechanistic and prospective studies.</p>

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Exaggerated thymic involution in late-onset myasthenia gravis: clinical and immunological evidence

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月31日

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  • Yu-Xin Wang,
  • Tong Du,
  • Heng Li,
  • Peng-Xi Han,
  • Chang Liu,
  • Jia-Meng Lu,
  • Xiao-Li Li,
  • Bin Liu,
  • Yu-Yao Zhai,
  • Xin-Hua Zhao,
  • Guang-You Duan,
  • Rui-Sheng Duan,
  • Min Zhang

摘要

Background

The thymus is critical in the pathogenesis of early-onset myasthenia gravis (EOMG), whereas its involvement in late-onset myasthenia gravis (LOMG) remains controversial. Herein, we systematically analyzed thymic computed tomography (CT) images and evaluated thymic output in patients with LOMG.

Results

We retrospectively examined the chest CT images and clinical profiles of 59 patients with LOMG, 16 patients with EOMG, and 225 matched controls from our center. These data were acquired at the time of diagnosis and before any immunotherapy. The key CT features, thymic volume, surface area, and density (represented by gray value), were assessed quantitatively and compared between groups. In a separate flow-cytometry cohort, circulating naïve T cells and recent thymic emigrants (RTEs) were analyzed in 20 immunotherapy-naïve LOMG patients and 27 healthy matched controls. Patients with LOMG showed lower thymic gray value and larger thymic volume and surface area compared with controls. Thymic volume was positively correlated with BMI and LOMG patients with diabetes had larger thymus than those without. Multivariate Logistic regression analysis revealed that thymic volume, surface area, and gray value were associated with the risk of LOMG. In the independent flow-cytometry cohort, patients with LOMG also exhibited reduced circulating RTEs, suggesting impaired thymic output.

Conclusions

Patients with LOMG showed exaggerated thymic involution and reduced thymic output, supporting thymic involvement in the pathophysiology of LOMG. These findings provide clues for future mechanistic and prospective studies.