Establish diagnosis unequivocally (see Table 386-1 in HPIM-18)

MRI of brain (if positive, reassess)

Anticholinesterase (pyridostigmine)

Intensive care (tx respiratory infection; fluids)

Anticholinesterase (pyridostigmine)

Evaluate for thymectomy (indications: thymoma or generalized MG); evaluate surgical risk, FVC

If unsatisfactory

Evaluate clinical status; if indicated, go to immunosuppression

Immunosuppression

See text for short-term, intermediate, and long-term treatments

Thymectomy

End

Plasmapheresis or intravenous lg

then

Improved

If not improved

Generalized

Search for associated conditions (see Table 381-3 in HPIM-18)

Ocular only

Generalized

Crisis

Good risk (good FVC)

Poor risk (low FVC)