Take what I'm about to say with a grain of salt. I'm no expert, just another MG patient. But I've read a ton on MG and have talked to a lot of others with it.

In my experience, the people with pure bulbar MG, or who have very prominent, mostly bulbar symptoms, who aren't MuSK positive and aren't elderly, have had thymomas. I'm pretty sure that it's because another antibody is at work, one that also tends to be present in elderly folks who develop MG (but don't have a thymoma), but not younger folks who also don't have a thymoma (sorry, kinda confusing).

If you do have a thymoma, I know it seems frightening, but it doesn't have to be as frightening as it seems. Things can fluctuate after the surgery, but not so far from where you are right now, especially since you're already on immunosuppresants. The thymomas are almost always benign.

Based on what I've read about surgery, if you have a thymoma, or it's suspected, I'd just opt for the sternotomy. You want to make sure that it's all out, as they tend to come back if there's any tissue lingering (like any type of cancer).

Rest assured that of all the cancers you can get, as per what my surgeon said, this is the one you'd want if you had a choice. The only trouble the thymoma people with MG have is the MG itself. It's a rough road, but your symptoms are already well-controlled so things should only get better from here, especially after the surgery. In fact, you could get completely better. I have read that that happens.

Ttys!
Nicky