Thymic Involvement in the Pathophysiology of Myasthenia Gravis

The precise mechanisms underlying autoantibody generation in myasthenia gravis (MG) remain incompletely understood. Evidence suggests an important role of the thymus in the initiation and maintenance of the autoimmune response. Thymic abnormalities, including thymic follicular hyperplasia and thymoma, are frequently observed in MG and are associated with distinct pathological features. In thymic hyperplasia, ectopic germinal center formation promotes B-cell activation and sustained autoantibody production, whereas thymoma is associated with impaired T-cell development and may also exhibit ectopic germinal center formation. These contribute to the dysfunction of central immune tolerance and the dysregulation of peripheral immune responses. This review summarizes the immunological mechanisms linking thymic pathology to MG pathogenesis.