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Infant Thymectomy, Immune malfunction
Posted by: Heidi
Date: August 30, 2004 10:30 AM

Infant 4.6 months old, 6.5 pounds. Large perimembranous ventrical septal defect surgically repaired. Incidental thymectomy. Thymus weight 4.4grams, exact size of a newborn thymus. What is post operative protocol/possible complications due to thymectomy? I'm interested in the technical side of exactly what is done for children in this situation. I'm also interested in what you feel "should" be done for them. Any links or references that can be given would be greatly appreciated. As a side note, it is apparently common practice to do a thymectomy in infants and children during heart surgery. There are medical websites stating this causes everything from autoimmune diseases to complete immune system failure, yet it continues to be common practice and opinions and articles on the subject vary greatly depending on who you ask or where you search for your information. One article even lists that, "Children who have had a thymectomy early in life represent an important group in the study of the development of the immune system." (see: [www.medicine.uiowa.edu]). This sounds very much like these unfortunate children have become a live group of lab rats. This seems archaic and inhumane to me. I was not even told my small baby had a thymectomy during his heart surgery. He now suffers from the same problems DiGeorges syndrome children suffer (children born without a thymus). The very hospital who did this to my child infact did a genetic test less than a year later for DiGeorge's syndrome when my son developed wasting and scoliosis. They then blamed him, saying he has a birth defect. I wonder how many other children suffer this same fate.

RE: Infant Thymectomy, Immune malfunction
Posted by: Ron Kennedy, M.D.
Date: August 30, 2004 1:25 PM

The thymus is the master gland of immunity, and removing this gland weakens the body's ability to fight infections and cancer. The thymus normally shrinks and becomes less useful with age and few people by age 40 even have a functioning thymus. It would seem logical that thymectomy in a younger person could have greater negative long term consequences than thymectomy in an older person. Nevertheless, the thymus is commonly removed during heart surgery in children and in treatment of thymoma and myaesthenia gravis. Given the location of the thymus it may have been necessary to remove it during heart surgery in your child's case. Nevertheless, not getting your permission to remove it and not informing you that it was removed smacks of malpractice. In your place I might look for legal as well as medical advice. Here is an article I found (reproduced below):

The influence of partial or total thymectomy during open heart surgery in infants on the immune function later in life: Clinical & Experimental Immunology May 2004, vol. 136, no. 2, pp. 349-355(7) EYSTEINSDOTTIR J.H.; FREYSDOTTIR J.[1]; HARALDSSON A.[2]; STEFANSDOTTIR J.[1]; SKAFTADOTTIR I.[3]; HELGASON H.[2]; OGMUNDSDOTTIR H.M.[4] [1] Lyfjathroun hf Biopharmaceuticals, Reykjavik, [2] Children's Hospital Iceland, Reykjavik, and [3] Department of Immunology, Landspitali University Hospital, Reykjavik, Iceland [4] Faculty of Medicine, University of Iceland, Reykjavik,

Abstract:
SUMMARY
Infants undergoing open heart surgery often have all or part of their thymus removed. The activity of the immune system has not been investigated thoroughly in these children, and only shortly after the operation. Therefore, it was decided to investigate the activity of the immune system in more detail in children several years after their operation. Peripheral blood samples from 19 children who had undergone open heart surgery during their first months of life was collected (study group) and from 19 age- and gender-matched children (control group). The activity of the immune system was evaluated by measuring the number of different cell types in peripheral blood, the phenotype of lymphocytes and the response of T cells following in vitro stimulation by mitogen, tetanus toxoid and measles antigen. The study group had significantly lower counts of total lymphocytes, which was reflected in a lower number of T cells but not B cells. Furthermore, the study group had significantly lower proportion of T cells (CD3+) and helper T cells (CD4+), but not cytotoxic T cells (CD8+). The level of neutrophils in peripheral blood was significantly higher in the study group. This may indicate enhanced innate immunity when the acquired immunity is defective. The results indicate a shift to extrathymic T cell maturation, which is less efficient for CD4+ helper cells than for CD8+ cytotoxic cells.

It appears that there is no standard treatment for infantile thymectomy and that this group of patients has been more ot less swept under the rug. One treatment I have seen as mentioned is administration of intravenous immunoglobulin, but I believe that is reserved for people fighting and infection. Another treatment which I have seen mentioned is transplantation of the thymus but I believe this applies to people born without a thymus (DiGeorge's syndrome). It might be very complicted to carry this out in a person who has had a thymus but no longer does due to transplant rejection phenomena. Of course it would be easy to tell you to consult an endocrinologist, but since this group of patients has not been very well studied, you may find an endocrinologist as baffled as I am. Perhaps you should call Dr. J. H. Eysteinsdorrit at the Faculty of Medicine, University of Iceland, Reykjavik who authored the above article. It would seem that he is one of the few people who has even taken an interest in studying the problem. In the meantime, it surely would do no harm to administer Thymic Protein A (I think you can order this on-line) and thymus glandulars (easily obtained in health food stores). How much these would help in the absence of a thymus gland is a question I can't answer.



This Thread has been closed

 




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