Forty-seven consecutively presenting myasthenia gravis (MG) patients with generalized weakness were treated according to a standardized prospective protocol. All patients underwent a sternal splitting "total" thymectomy. Medical status before surgery was optimized by plasmapheresis without immunosuppression. Medications were avoided or discontinued whenever possible. All patients were improved. At the time of latest follow-up 83% were free of generalized weakness and 61% were on no medications. There was no significant change in Acetylcholine Receptor Antibody (AChR-AB) titer. The following conclusions were made: (1) thymectomy is an effective therapy for MG, (2) additional medications are not necessary in the majority of patients, and (3) a reduction in the AChR-AB titer is not essential for clinical benefit.