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PubMed This is a summary of 17 peer-reviewed journal articles Updated
Oncology

Standard of Care: Managing Tumor and Immune Health

At a Glance

Good syndrome requires two coordinated plans: treating the thymoma, often with surgery, and supporting the weakened immune system with immunoglobulin replacement, infection prevention, vaccine review, and individualized monitoring. Removing the tumor alone does not restore immunity.

Managing Good syndrome requires a coordinated approach: one team focuses on the thymoma (the tumor), while another manages the immunodeficiency (the weakened immune system). Because treating the tumor does not restore the immune system, both aspects require careful, individualized management [1][2].

Managing the Thymoma: The Oncology Plan

Surgery is the standard treatment for many resectable thymomas. The goal of a thymectomy is a “complete resection,” meaning the entire tumor and any affected surrounding tissue are removed [3].

  • Surgical Approaches:
    • VATS or Robotic Surgery: For smaller, early-stage tumors, surgeons often use minimally invasive techniques. These involve small incisions and a camera, leading to faster recovery [4][5].
    • Open Sternotomy: If the tumor is large, locally invasive, or requires extensive margins, a traditional open surgery may be used [3][6].
  • Additional Therapies: Depending on the stage, invasion, and pathology of the tumor, your oncology team might recommend radiation, induction chemotherapy, or multimodal treatment before or after surgery [7][8].

Managing the Immune Deficit: The Immunology Plan

Because your body cannot produce enough antibodies, you will likely need immunoglobulin replacement therapy [9][2]. This treatment provides donor antibodies to help you fight off everyday bacteria.

There are two main ways to receive these antibodies:

  1. IVIG (Intravenous Immunoglobulin): Infusions given into a vein, usually every 3 to 4 weeks in a clinic [10].
  2. SCIG (Subcutaneous Immunoglobulin): Smaller, more frequent doses injected under the skin, often done at home [11].

What to expect with infusions: Some patients experience temporary side effects like headaches, fatigue, or local reactions at the injection site. Stay hydrated and never alter your dose without consulting your team.
Monitoring Success: Your doctor will check your trough level—the amount of IgG in your blood just before your next dose. There is no single universal target number for Good syndrome; rather, the dose is highly individualized based on your infection frequency, any organ damage (like bronchiectasis), pharmacokinetics, and tolerability [10].

Preventing and Treating Infections

Because Good syndrome also affects your T cells, your defenses against certain opportunistic infections are compromised.

  • Prophylactic (Preventative) Medications: These are not automatic for everyone. Depending on your CD4 count and history, your immunologist may consider individualized prophylaxis for Pneumocystis jirovecii (PJP, often using TMP-SMX), or specific antivirals if you have active or recurrent HSV or CMV disease [12][13].
  • Vaccination Strategies: You should have all vaccines reviewed by your immunologist. While non-live vaccines are generally safe, they may produce a weak response. Live vaccines (like MMR or yellow fever) are often avoided due to your T-cell dysfunction, but the decision depends on your specific immune impairment and whether your immunoglobulin infusions might interfere with the vaccine [14][12].
  • Active Infection Management: If you get sick, you must contact your infectious disease or immunology team promptly. Treatment is pathogen- and organ-specific. You may require prompt, prolonged, or specialist-directed therapy [15][16]. Do not start standby antibiotics on your own without a clear, pre-agreed plan from your specialist, as this can lead to toxicity or antimicrobial resistance [17].

Common questions in this guide

How is Good syndrome treated?
Good syndrome requires two coordinated plans: treatment of the thymoma and support for the weakened immune system. Surgery is the standard treatment for many thymomas that can be removed, while immunology care often includes immunoglobulin replacement and infection prevention. Treating the tumor alone does not restore immune function.
Can removing the thymoma cure the immune deficiency?
No. Thymoma treatment does not usually restore the body’s ability to make enough antibodies or correct the associated T-cell problems. Ongoing immunology care and immunoglobulin replacement may still be needed after surgery.
Is IVIG or SCIG better for Good syndrome?
Both IVIG and SCIG provide donor antibodies to help prevent infections. IVIG is usually given into a vein every three to four weeks in a clinic, while SCIG uses smaller doses under the skin more often and can often be given at home. The best option depends on your medical needs, treatment response, tolerability, and lifestyle.
What does a trough IgG level mean in Good syndrome?
A trough IgG level is the amount of IgG in your blood just before the next immunoglobulin dose. There is no single target level that applies to everyone with Good syndrome. Doctors individualize dosing based on infections, organ damage such as bronchiectasis, how your body handles the treatment, and side effects.
Do people with Good syndrome need preventive antibiotics or antivirals?
Preventive medicines are not automatically needed for everyone. An immunologist may consider Pneumocystis jirovecii prevention with TMP-SMX based on your CD4 count and infection history, or antiviral treatment when HSV or CMV disease is active or recurrent. Do not start these medicines without a specialist’s plan.
Are vaccines safe if I have Good syndrome?
Non-live vaccines are generally considered safer, but they may not produce a strong immune response. Live vaccines are often avoided when T-cell function is impaired, and immunoglobulin infusions can affect the timing or response to some vaccines. Have every vaccine reviewed by your immunologist first.
What should I do if I develop signs of an infection?
Contact your infectious disease or immunology team promptly so they can determine the likely pathogen, affected organ, and appropriate treatment. Infections may require prompt, prolonged, or specialist-directed therapy. Do not use standby antibiotics on your own unless you have a clear plan agreed on in advance with your specialist.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Based on the size and stage of my thymoma, what surgical approach (VATS, robotic, open) or adjuvant therapies are recommended?
  2. 2.What is my target 'trough' IgG level for my immunoglobulin infusions, and how often will we measure it?
  3. 3.Which immunoglobulin method (IVIG or SCIG) would you recommend for my lifestyle and medical needs?
  4. 4.Given my CD4 count and history, is there a specific need for preventative antibiotics like Bactrim for PJP?
  5. 5.Who should I contact immediately if I suspect an infection, so we can determine the right antibiotic and dose?
  6. 6.Which specific vaccines should I get, and which must I have reviewed by my immunologist before receiving?

Questions For You

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References

References (17)
  1. 1

    Pure Red Cell Aplasia and Other Haematological Diseases Associated With Thymoma: A Case Series and Systematic Review.

    Yen CC, Huang WL, Li SS, et al.

    Frontiers in medicine 2021; (8()):759914 doi:10.3389/fmed.2021.759914.

    PMID: 34966753
  2. 2

    Clinical Characteristics, Surgical Risks, and Long-Term Prognosis of Good's Syndrome.

    Otsuka S, Shiiya H, Sasaki A, et al.

    Cureus 2026; (18(6)):e111036 doi:10.7759/cureus.111036.

    PMID: 42491992
  3. 3

    Surgical treatment of thymic epithelial tumors: a narrative review.

    Agrafiotis AC, Berzenji L, Koyen S, et al.

    Mediastinum (Hong Kong, China) 2024; (8()):32 doi:10.21037/med-23-44.

    PMID: 38881810
  4. 4

    Robot-Assisted Versus Video-Assisted Thymectomy: A Narrative Review of Current Evidence.

    Bae SY, Na KJ

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 2026; (68(12 Suppl 2)):i1-i7 doi:10.1093/ejcts/ezag005.

    PMID: 42102247
  5. 5

    Multi-institutional European experience of robotic thymectomy for thymoma.

    Marulli G, Maessen J, Melfi F, et al.

    Annals of cardiothoracic surgery 2016; (5(1)):18-25 doi:10.3978/j.issn.2225-319X.2015.08.13.

    PMID: 26904427
  6. 6

    Surgical management of thymic tumors: a narrative review with focus on robotic-assisted surgery.

    Deckarm R, Flury DV, Deckarm S, et al.

    Mediastinum (Hong Kong, China) 2024; (8()):48 doi:10.21037/med-24-17.

    PMID: 39781201
  7. 7

    An Updated Review on Radiation Treatment Management in Thymus Cancers.

    Liu J, Govindarajan A, Williams TM, et al.

    Clinical lung cancer 2022; (23(7)):561-570 doi:10.1016/j.cllc.2022.07.004.

    PMID: 35941046
  8. 8

    Surgical, Radiation, and Systemic Treatments of Patients With Thymic Epithelial Tumors: A Systematic Review.

    Falkson CB, Vella ET, Ellis PM, et al.

    Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 2023; (18(3)):299-312 doi:10.1016/j.jtho.2022.10.016.

    PMID: 36343922
  9. 9

    Good's syndrome presenting with CMV pneumonitis and oesophageal candidiasis: A case report.

    Kwok CT, Yeung YC

    Respirology case reports 2022; (10(1)):e0888 doi:10.1002/rcr2.888.

    PMID: 34888060
  10. 10

    Features and outcomes of immunoglobulin therapy in patients with Good syndrome at Thailand's largest tertiary referral hospital.

    Thongngarm T, Boonyasiri A, Pradubpongsa P, et al.

    Asian Pacific journal of allergy and immunology 2019; (37(2)):109-115 doi:10.12932/AP-131117-0196.

    PMID: 29888926
  11. 11

    Subcutaneous Immunoglobulin Therapy for Hypogammaglobulinemia Secondary to Malignancy or Related Drug Therapy.

    Windegger TM, Lambooy CA, Hollis L, et al.

    Transfusion medicine reviews 2017; (31(1)):45-50 doi:10.1016/j.tmrv.2016.06.006.

    PMID: 27450021
  12. 12

    Prevention of infectious diseases in patients with Good syndrome.

    Multani A, Gomez CA, Montoya JG

    Current opinion in infectious diseases 2018; (31(4)):267-277 doi:10.1097/QCO.0000000000000473.

    PMID: 29878906
  13. 13

    [Patient with Good's syndrome and COVID-19. Report of a clinical case].

    Maldonado-Domínguez ED, O Farrill-Romanillos PM

    Revista medica del Instituto Mexicano del Seguro Social 2022; (60(4)):474-479.

    PMID: 35819306
  14. 14

    Missed and misdiagnosis of immunodeficiency: Good syndrome presenting as persistent COVID-19 shedding.

    Chiang V, So TCH, Li PH

    Asia Pacific allergy 2025; (15(3)):235-237 doi:10.5415/apallergy.0000000000000171.

    PMID: 40933428
  15. 15

    Good's Syndrome Complicated with COVID-19 and Recurrent Pulmonary Infections: A Case Report.

    Xia W, Wu M, He F

    Iranian journal of allergy, asthma, and immunology 2026; (25(2)):269-278 doi:10.18502/ijaai.v25i2.20805.

    PMID: 42113501
  16. 16

    Good's syndrome with opportunistic infection of the central nervous system: a case report.

    Ueno S, Sekimoto-Tsuboi S, Ishiguro Y, et al.

    BMC neurology 2015; (15()):150 doi:10.1186/s12883-015-0406-1.

    PMID: 26303293
  17. 17

    Metagenomic next-generation sequencing for pathogen detection of pulmonary infections in persons living with HIV.

    Zhang Y, Guo S, Lu L, et al.

    AIDS research and therapy 2025; (22(1)):95 doi:10.1186/s12981-025-00801-0.

    PMID: 41024077

This page explains treatment and immune-management options for Good syndrome for informational purposes only and does not constitute medical advice. Your oncology, immunology, and infectious disease teams should tailor surgery, immunoglobulin therapy, vaccines, and infection treatment to your situation.

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