Objective To investigate the role of T follicular helper cells (TFH) and their expression of α7 nicotinic acetylcholine receptor (α7nAChR) in patients with Myasthenia gravis (MG). Methods Fifteen MG patients who underwent surgical treatment in the Myasthenia Gravis Comprehensive Diagnosis and Treatment Center of Henan Provincial People's Hospital from June 2022 to June 2023 were selected as the MG group, including 7 males and 8 females, aged 12-30 years. Twelve healthy individuals who underwent partial thymectomy without obstruction during cardiac surgery in Fuwai Central China Cardiovascular Hospital from June 2022 to June 2023 were selected as the healthy control group, including 5 males and 7 females aged 20-35 years. Thymus single cell suspension was obtained by grinding the thymus tissue, and flow cytometry was used to detect the expression of α7nAChR in TFH cells. The thymus cell suspension was purified using density gradient centrifugation, followed by immunomagnetic bead separation to obtain CD4+T cells. CXCR5 antibody and coupled magnetic beads were added to isolate TFH cells. Real-time fluorescent polymerase chain reaction (RT-PCR) and Western blotting were performed to further investigate the expression of α7nAChR in TFH cells. Results Compared with the healthy control group, there was a significant decrease in α7nAChR levels within thymic TFH cells in the MG group (P<0.001), along with significantly decreased mRNA and protein expression levels of α7nAChR within these cells (P<0.01). Conclusion The findings suggest that there is a reduced expression of α7nAChR within thymic TFH cells in MG patients, leading to weakened immunosuppressive function which may indirectly contribute to disease onset and progression.