A 73-year-old man presented with cervical cord compression resulting from a metastatic spindle cell thymoma 10 years after undergoing thymectomy for thymoma-associated myasthenia gravis. After being virtually asymptomatic following thymectomy, his myasthenic symptoms returned 3 months after removal of the spinal metastasis, culminating in myasthenic crisis that required immunosuppression and plasma exchange This case shows that isolated, extrathoracic metastases without any mediastinal tumor may occur many years after apparent surgical cure of primary thymoma, and that myasthenia gravis may recur after surgical resection of a thymic metastasis.