Cardiorespiratory Rehabilitation Management of Generalized Myasthenia Gravis Post Thymectomy and Radiotherapy With Type II Obesity

Abstract

Background: Generalized myasthenia gravis (MG) is an autoimmune neuromusculardisorder that can reduce respiratory reserve, impair cough effectiveness, and limit dailyactivities. These limitations may be exacerbated by thymoma, obesity, previous myastheniccrisis, and post-thymectomy or post-radiotherapy status. Cardiorespiratory rehabilitation mayaddress both physiologic and functional impairments through symptom-limited exercise,breathing retraining, airway-clearance techniques, and energy conservation strategies.

Case: A 39-year-old woman with AChR-positive generalized MG, status post extendedthymectomy for thymoma and radiotherapy, was referred to Physical Medicine andRehabilitation because of easy fatigability, exertional dyspnea, and reduced tolerance fordaily activities. Baseline evaluation revealed class II obesity, reduced chest expansion,restrictive spirometry, weak cough, low exercise tolerance, impaired functional endurance,and moderate limitations in daily function and quality of life.

Discussion: The patient’s limitations reflected a multifactorial cardiorespiratory conditioninvolving neuromuscular weakness, reduced thoracic mobility, and obesity. The rehabilitationprogram included graded aerobic exercise, breathing retraining, incentive spirometry, airwayclearanceeducation, and energy conservation strategies. After six weeks, the patientdemonstrated reduced fatigue and dyspnea, improved cough effectiveness, increased chestexpansion, and greater walking capacity.

Conclusion: Cardiorespiratory rehabilitation produced clinically meaningful functionalimprovement in a patient with generalized MG after thymectomy and radiotherapy despitecoexisting class II obesity. These findings suggest that functional limitations in MG aremodifiable and can respond to a structured rehabilitation program, although long-term followupand weight management remain essential.