First of all, it is clear that the therapeutic effect of pyridostigmine is symptomatic but not causative. We know that myasthenia gravis is an autoimmune disease with impaired acetylcholine transmission at the neuromuscular junction, and the effect of pyridostigmine is only a relative increase in the amount of acetylcholine at the synaptic gap, which only treats the symptoms but not the root cause, and does not touch the pathogenesis of myasthenia gravis: autoimmune abnormalities. Therefore, we call pyridostigmine symptomatic replacement therapy. When the patient’s immune system is corrected by the application of hormones or other immunosuppressive agents or by changes in the body itself, the clinical symptoms of myasthenia gravis improve, the disease no longer fluctuates significantly, and taking pyridostigmine or not no longer has an effect on the symptoms, there is no point in using pyridostigmine anymore. At this point, pyridostigmine can be discontinued under the guidance of a physician, at which point the patient may still be taking hormones or other immunosuppressive drugs, which are not conflicting. Therefore, an older patient with well-controlled myasthenia gravis may well try to reduce the dose of pyridostigmine or even discontinue it. Of course, this should be done under the supervision of an experienced physician.